Provider Demographics
NPI:1912995804
Name:AKRIDGE, A. ALAN (DMD,PSC)
Entity Type:Individual
Prefix:DR
First Name:A.
Middle Name:ALAN
Last Name:AKRIDGE
Suffix:
Gender:M
Credentials:DMD,PSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12414 SHELBYVILLE RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40243-1419
Mailing Address - Country:US
Mailing Address - Phone:502-244-0204
Mailing Address - Fax:
Practice Address - Street 1:12414 SHELBYVILLE RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40243-1419
Practice Address - Country:US
Practice Address - Phone:502-244-0204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY37161223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60037165Medicaid