Provider Demographics
NPI:1598825473
Name:DENTAL HEALTH SPECIALISTS OF KENTUCKY
Entity Type:Organization
Organization Name:DENTAL HEALTH SPECIALISTS OF KENTUCKY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:G
Authorized Official - Last Name:ANGELL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:502-425-3350
Mailing Address - Street 1:4101 W HWY 146
Mailing Address - Street 2:PO BOX 433
Mailing Address - City:BUCKNER
Mailing Address - State:KY
Mailing Address - Zip Code:40010-0433
Mailing Address - Country:US
Mailing Address - Phone:502-222-2922
Mailing Address - Fax:502-222-5922
Practice Address - Street 1:4101 W HWY 146
Practice Address - Street 2:
Practice Address - City:BUCKNER
Practice Address - State:KY
Practice Address - Zip Code:40010-0433
Practice Address - Country:US
Practice Address - Phone:502-222-2922
Practice Address - Fax:502-222-5922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty