Provider Demographics
NPI:1972936870
Name:AHRENS, DOUGLAS GERARD II (DMD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:GERARD
Last Name:AHRENS
Suffix:II
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:GERRY
Other - Middle Name:
Other - Last Name:AHRENS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:2015 HERR LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-6567
Mailing Address - Country:US
Mailing Address - Phone:502-426-2744
Mailing Address - Fax:502-426-2747
Practice Address - Street 1:2015 HERR LN
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-6567
Practice Address - Country:US
Practice Address - Phone:502-426-2744
Practice Address - Fax:502-426-2747
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-14
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY89571223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics