Provider Demographics
NPI:1932098613
Name:DENTAL SLEEP MEDICINE OF KENTUCKY, PSC
Entity type:Organization
Organization Name:DENTAL SLEEP MEDICINE OF KENTUCKY, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:COSTELLO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:502-308-4546
Mailing Address - Street 1:2811 BARDSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40205-2677
Mailing Address - Country:US
Mailing Address - Phone:502-308-4546
Mailing Address - Fax:502-308-4243
Practice Address - Street 1:2811 BARDSTOWN RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205-2677
Practice Address - Country:US
Practice Address - Phone:502-308-4546
Practice Address - Fax:502-308-4243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-30
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty