Organization
BRADLEY G ANGELL, DMD, MS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRADLEY G ANGELL DMD, MS (OWNER)
(502) 425-3350
Entity
Organization
Contact information
Practice address
10412 SHELBYVILLE RD, LOUISVILLE, KY 40223-3120
(502) 425-3350
(502) 425-3789
Mailing address
10412 SHELBYVILLE RD, LOUISVILLE, KY 40223-3120
(502) 425-3350
(502) 425-3789
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
4934
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1695639
UCCI
IN
01
—
506626
UCCI
KY
Enumeration date
11/30/2006
Last updated
08/22/2020
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