Provider Demographics
NPI:1205229796
Name:ADVANCED DENTAL AESTHETICS NY
Entity Type:Organization
Organization Name:ADVANCED DENTAL AESTHETICS NY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LOUIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KHOURI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:212-421-8180
Mailing Address - Street 1:901 E 14 MILE RD
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-2038
Mailing Address - Country:US
Mailing Address - Phone:212-421-8180
Mailing Address - Fax:212-421-8182
Practice Address - Street 1:33 BLOOMFIELD HILLS PKWY
Practice Address - Street 2:SUITE 140
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48304-2944
Practice Address - Country:US
Practice Address - Phone:212-421-8180
Practice Address - Fax:212-421-8182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-09
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty