Healthcare Provider Details

I. General information

NPI: 1154649705
Provider Name (Legal Business Name): MATTHEW ALAN AKRIDGE D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2010
Last Update Date: 05/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12405 OLD SHELBYVILLE RD
LOUISVILLE KY
40243-1505
US

IV. Provider business mailing address

PO BOX 43728
LOUISVILLE KY
40253-0728
US

V. Phone/Fax

Practice location:
  • Phone: 502-244-0204
  • Fax: 502-244-5683
Mailing address:
  • Phone: 502-244-0204
  • Fax: 502-244-5683

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number836
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: