Provider Demographics
NPI:1588675805
Name:KOVAL, JOSEPH A (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:A
Last Name:KOVAL
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 1:130 STONECREST RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SHELBYVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40065-8126
Mailing Address - Country:US
Mailing Address - Phone:502-633-1584
Mailing Address - Fax:502-633-1509
Practice Address - Street 1:130 STONECREST RD
Practice Address - Street 2:SUITE 101
Practice Address - City:SHELBYVILLE
Practice Address - State:KY
Practice Address - Zip Code:40065-8126
Practice Address - Country:US
Practice Address - Phone:502-633-1584
Practice Address - Fax:502-633-1509
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY71101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice