Provider Demographics
NPI:1801955448
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 1:9494 BROWNSBORO RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40241-1118
Mailing Address - Country:US
Mailing Address - Phone:502-326-0001
Mailing Address - Fax:502-426-2612
Practice Address - Street 1:9494 BROWNSBORO RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-1118
Practice Address - Country:US
Practice Address - Phone:502-326-0001
Practice Address - Fax:502-426-2612
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
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty