Provider Demographics
NPI:1760525604
Name:AL PELPHREY DMD PSC
Entity Type:Organization
Organization Name:AL PELPHREY DMD PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AL
Authorized Official - Middle Name:
Authorized Official - Last Name:PELPHREY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:606-437-1461
Mailing Address - Street 1:300 N MAYO TRL
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41501-1563
Mailing Address - Country:US
Mailing Address - Phone:606-437-1461
Mailing Address - Fax:
Practice Address - Street 1:300 N MAYO TRL
Practice Address - Street 2:SUITE 1
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-1563
Practice Address - Country:US
Practice Address - Phone:606-437-1461
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY6229122300000X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty