Provider Demographics
NPI:1275124323
Name:ADVANCED IMPLANT CENTERS LLC
Entity Type:Organization
Organization Name:ADVANCED IMPLANT CENTERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:SCHROERING
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:765-293-4200
Mailing Address - Street 1:1215 WINTERBRANCH WAY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40245-6533
Mailing Address - Country:US
Mailing Address - Phone:765-293-4200
Mailing Address - Fax:
Practice Address - Street 1:1215 WINTERBRANCH WAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40245-6533
Practice Address - Country:US
Practice Address - Phone:765-293-4200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-01
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty