Provider Demographics
NPI:1851450407
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:502-423-9111
Mailing Address - Street 1:9505 WILLIAMSBURG PLZ
Mailing Address - Street 2:SUITE 301
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-5082
Mailing Address - Country:US
Mailing Address - Phone:502-423-9111
Mailing Address - Fax:502-423-9330
Practice Address - Street 1:9505 WILLIAMSBURG PLZ
Practice Address - Street 2:SUITE 301
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-5082
Practice Address - Country:US
Practice Address - Phone:502-423-9111
Practice Address - Fax:502-423-9330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
Not Answered1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty