Provider Demographics
NPI:1275320830
Name:AMS DENTAL
Entity type:Organization
Organization Name:AMS DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AL-HARITH
Authorized Official - Middle Name:
Authorized Official - Last Name:SHALASH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:859-253-0711
Mailing Address - Street 1:624 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40508-1436
Mailing Address - Country:US
Mailing Address - Phone:859-253-0711
Mailing Address - Fax:
Practice Address - Street 1:624 N BROADWAY
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40508-1436
Practice Address - Country:US
Practice Address - Phone:859-253-0711
Practice Address - Fax:859-254-0990
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMS DENTAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-04-24
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental