Healthcare Provider Details

I. General information

NPI: 1801712856
Provider Name (Legal Business Name): BLUEGRASS ORAL PATHOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 CODELL DR STE 240
LEXINGTON KY
40509-1178
US

IV. Provider business mailing address

80 CODELL DR STE 240
LEXINGTON KY
40509-1178
US

V. Phone/Fax

Practice location:
  • Phone: 606-233-2823
  • Fax:
Mailing address:
  • Phone: 606-233-2823
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code292200000X
TaxonomyDental Laboratory
License Number
License Number State

VIII. Authorized Official

Name: DR. MOLLY HOUSLEY SMITH
Title or Position: OWNER
Credential: DMD
Phone: 606-233-2823