MEDICARE: DENTAL HEALTH SPECIALISTS OF KENTUCKY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry

General Provider Information

NPI Number	:	1487713186
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENTAL HEALTH SPECIALISTS OF KENTUCKY

Provider Business Mailing Address
First Line	:	4229 BARDSTOWN RD
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40218-3241
Country	:	US
Telephone Number	:	502-491-6480
Fax Number	:	502-491-1987

Provider Business Practice Location Address
First Line	:	4229 BARDSTOWN RD
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40218-3241
Country	:	US
Telephone Number	:	502-491-6480
Fax Number	:	502-491-1987

Authorized Official
Title or Position	:	OWNER
Name	:	BRADLEY G ANGELL
Credential	:	DMD
Telephone Number	:	502-425-3350

Provider Enumeration Date	:	12/08/2006
Last Update Date	:	08/22/2020

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