Provider Demographics
NPI:1104224849
Name:BLUEGRASS ORAL HEALTH CENTER PLLC
Entity type:Organization
Organization Name:BLUEGRASS ORAL HEALTH CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:M
Authorized Official - Last Name:BURT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:270-781-6161
Mailing Address - Street 1:546 PARK ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-1780
Mailing Address - Country:US
Mailing Address - Phone:270-781-6161
Mailing Address - Fax:270-781-6129
Practice Address - Street 1:546 PARK ST
Practice Address - Street 2:SUITE 400
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-1780
Practice Address - Country:US
Practice Address - Phone:270-781-6161
Practice Address - Fax:270-781-6129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-11
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty