Provider Demographics
NPI:1912133620
Name:THE IMPLANT AND ORAL SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:THE IMPLANT AND ORAL SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORAL SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:R
Authorized Official - Last Name:MCLAURIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MD
Authorized Official - Phone:859-498-6204
Mailing Address - Street 1:204 BEVINS LN
Mailing Address - Street 2:SUITE F
Mailing Address - City:GEORGETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40324-6139
Mailing Address - Country:US
Mailing Address - Phone:502-863-1402
Mailing Address - Fax:502-863-1405
Practice Address - Street 1:204 BEVINS LN
Practice Address - Street 2:SUITE F
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324-6139
Practice Address - Country:US
Practice Address - Phone:502-863-1402
Practice Address - Fax:502-863-1405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-09
Last Update Date:2009-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Multi-Specialty