Healthcare Provider Details

I. General information

NPI: 1811817992
Provider Name (Legal Business Name): BLUEGRASS EXTRACTIONS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1065 DOVE RUN RD STE 1
LEXINGTON KY
40502-3524
US

IV. Provider business mailing address

2708 MARTINIQUE LN
LEXINGTON KY
40509-9509
US

V. Phone/Fax

Practice location:
  • Phone: 859-334-0671
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID JAMES HART
Title or Position: OWNER
Credential: DDS
Phone: 859-334-0671