Provider Demographics
NPI:1437365087
Name:BRIAN A. MARRILLIA DMD, PSC
Entity Type:Organization
Organization Name:BRIAN A. MARRILLIA DMD, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:MARRILLIA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:502-935-1414
Mailing Address - Street 1:6788 DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40258-3912
Mailing Address - Country:US
Mailing Address - Phone:502-935-1414
Mailing Address - Fax:502-935-1795
Practice Address - Street 1:6788 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40258-3912
Practice Address - Country:US
Practice Address - Phone:502-935-1414
Practice Address - Fax:502-935-1795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY75491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty