Provider Demographics
NPI:1952446023
Name:MARRILLIA, BRIAN A (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:A
Last Name:MARRILLIA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY75491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice