Provider Demographics
NPI:1447733753
Name:THE CENTER FOR AESTHETIC & IMPLANT DENTISTRY
Entity Type:Organization
Organization Name:THE CENTER FOR AESTHETIC & IMPLANT DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:T
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:502-403-0686
Mailing Address - Street 1:12010 SHELBYVILLE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40243-1095
Mailing Address - Country:US
Mailing Address - Phone:502-589-4671
Mailing Address - Fax:502-589-6584
Practice Address - Street 1:12010 SHELBYVILLE RD STE 100
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40243-1095
Practice Address - Country:US
Practice Address - Phone:502-589-4671
Practice Address - Fax:502-589-6584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-12
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental