Basic Information
| Provider Information | |||||||||
| NPI: | 1730531104 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ALBRIGHT | ||||||||
| FirstName: | DEREK | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | MR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 398 192ND ARMOR TANK BATTALION RD | ||||||||
| Address2: | USA DENTAC HQS BLDG 1022 | ||||||||
| City: | FORT KNOX | ||||||||
| State: | KY | ||||||||
| PostalCode: | 401215116 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5026246158 | ||||||||
| FaxNumber: | 5026242966 | ||||||||
| Practice Location | |||||||||
| Address1: | 289 IRELAND AVE | ||||||||
| Address2: | HOSPITAL DENTAL CLINIC BLDG 851 | ||||||||
| City: | FORT KNOX | ||||||||
| State: | KY | ||||||||
| PostalCode: | 401215111 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5026249670 | ||||||||
| FaxNumber: | 5026249778 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2016 | ||||||||
| LastUpdateDate: | 07/08/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 126800000X | Y | Dental Providers | Dental Assistant |
No ID Information.