Healthcare Provider Details

I. General information

NPI: 1912995804
Provider Name (Legal Business Name): A. ALAN AKRIDGE D.M.D.,P.S.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12414 SHELBYVILLE RD
LOUISVILLE KY
40243-1419
US

IV. Provider business mailing address

12414 SHELBYVILLE RD
LOUISVILLE KY
40243-1419
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number3716
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: