Provider Demographics
NPI:1043229545
Name:GOULD, ALAN R (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:R
Last Name:GOULD
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1941 BISHOP LN STE 1018
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40218-1928
Mailing Address - Country:US
Mailing Address - Phone:502-456-6217
Mailing Address - Fax:502-456-4440
Practice Address - Street 1:5805 W HIGHWAY 22
Practice Address - Street 2:
Practice Address - City:CRESTWOOD
Practice Address - State:KY
Practice Address - Zip Code:40014-7244
Practice Address - Country:US
Practice Address - Phone:502-241-7116
Practice Address - Fax:502-241-2339
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010715A1223P0106X
KY49251223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY2444790000OtherPASSPORT ADVANTAGE
IN200022760Medicaid
6222055OtherCIGNA HEALTHCARE
P00155545OtherRAILROAD MEDICARE
ININ2097001Medicare PIN
KYT53933Medicare UPIN
KY0905001Medicare PIN
P00155545OtherRAILROAD MEDICARE
P00155545OtherRAILROAD MEDICARE