Healthcare Provider Details

I. General information

NPI: 1558640821
Provider Name (Legal Business Name): AKRIDGE ORTHODONTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2011
Last Update Date: 08/04/2011
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

12405 OLD SHELBYVILLE RD
LOUISVILLE KY
40243-1505
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 Number
License Number State

VIII. Authorized Official

Name: DR. MATT AKRIDGE
Title or Position: ORTHODONTIST
Credential: DMD
Phone: 502-244-0204