Organization
ADVANCED DENTAL CENTER, INC.
Active
Parent organization
ADVANCED DENTAL CENTER, INC
Other names
ADVANCED DENTAL CENTER, ADVANCED DENTAL CENTER EAST
Organization subpart
Yes
Provider details
NPI number
Legal business name
ADVANCED DENTAL CENTER, INC
Authorized official
DR. RACHEL TALIS DMD (PRESIDENT)
(502) 966-4367
Entity
Organization
Contact information
Practice address
1901 RUDY LN STE 4, LOUISVILLE, KY 40207-1384
(502) 966-4367
Mailing address
1901 RUDY LN STE 4, LOUISVILLE, KY 40207-1384
(502) 966-4367
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
7118
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
61900353
—
KY
Enumeration date
08/29/2018
Last updated
06/11/2019
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