Provider Demographics
NPI:1528221975
Name:DESHMUKH, ATUL M (DMD)
Entity Type:Individual
Prefix:DR
First Name:ATUL
Middle Name:M
Last Name:DESHMUKH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4390 CLEARWATER WAY
Mailing Address - Street 2:APT #708
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40515-6359
Mailing Address - Country:US
Mailing Address - Phone:502-649-9666
Mailing Address - Fax:
Practice Address - Street 1:2533 LARKIN RD
Practice Address - Street 2:THE KENTUCKY CENTER FOR ORAL AND MAXILLOFACIAL SURGERY
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-3278
Practice Address - Country:US
Practice Address - Phone:859-278-9376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-07
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY96421223S0112X, 204E00000X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100365770Medicaid
KY7100353980Medicaid