Provider Demographics
NPI:1215145230
Name:HEDGESPETH, SHELBY LEE JR (DMD)
Entity type:Individual
Prefix:DR
First Name:SHELBY
Middle Name:LEE
Last Name:HEDGESPETH
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:798 PORTLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BARDSTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40004-2539
Mailing Address - Country:US
Mailing Address - Phone:502-348-7378
Mailing Address - Fax:
Practice Address - Street 1:798 PORTLAND AVE
Practice Address - Street 2:
Practice Address - City:BARDSTOWN
Practice Address - State:KY
Practice Address - Zip Code:40004-2539
Practice Address - Country:US
Practice Address - Phone:502-348-7378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY84591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice