Provider Demographics
NPI:1588788038
Name:CRUSH, ALBERT LEE II (DMD)
Entity type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:LEE
Last Name:CRUSH
Suffix:II
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 1:7025 W HIGHWAY 22
Mailing Address - Street 2:
Mailing Address - City:CRESTWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:40014-9080
Mailing Address - Country:US
Mailing Address - Phone:502-241-9880
Mailing Address - Fax:
Practice Address - Street 1:7025 WEST HWY 22
Practice Address - Street 2:
Practice Address - City:CRESTWOOD
Practice Address - State:KY
Practice Address - Zip Code:40014-9080
Practice Address - Country:US
Practice Address - Phone:502-241-9880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY41591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice