Healthcare Provider Details

I. General information

NPI: 1043229545
Provider Name (Legal Business Name): ALAN R GOULD DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 02/22/2021
Certification Date: 02/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5805 W HIGHWAY 22
CRESTWOOD KY
40014-7244
US

IV. Provider business mailing address

1941 BISHOP LN STE 1018
LOUISVILLE KY
40218-1928
US

V. Phone/Fax

Practice location:
  • Phone: 502-241-7116
  • Fax: 502-241-2339
Mailing address:
  • Phone: 502-456-6217
  • Fax: 502-456-4440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number12010715A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number4925
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: