Healthcare Provider Details

I. General information

NPI: 1598825473
Provider Name (Legal Business Name): DENTAL HEALTH SPECIALISTS OF KENTUCKY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 W HWY 146
BUCKNER KY
40010-0433
US

IV. Provider business mailing address

4101 W HWY 146 PO BOX 433
BUCKNER KY
40010-0433
US

V. Phone/Fax

Practice location:
  • Phone: 502-222-2922
  • Fax: 502-222-5922
Mailing address:
  • Phone: 502-222-2922
  • Fax: 502-222-5922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: BRADLEY G ANGELL
Title or Position: OWNER
Credential: DMD
Phone: 502-425-3350