Healthcare Provider Details

I. General information

NPI: 1851450407
Provider Name (Legal Business Name): DENTAL HEALTH SPECIALISTS OF KENTUCKY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9505 WILLIAMSBURG PLZ SUITE 301
LOUISVILLE KY
40222-5082
US

IV. Provider business mailing address

9505 WILLIAMSBURG PLZ SUITE 301
LOUISVILLE KY
40222-5082
US

V. Phone/Fax

Practice location:
  • Phone: 502-423-9111
  • Fax: 502-423-9330
Mailing address:
  • Phone: 502-423-9111
  • Fax: 502-423-9330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: BRADLEY G ANGELL
Title or Position: OWNER
Credential: DMD
Phone: 502-423-9111