NPIMap

Organization Active NPI

Advanced Dental Center, Inc.

  • General Practice Dentistry
  • Louisville, KY
National Provider Identifier
1922580653
Registry record updated Jun 11, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
7118 Issued in KY
Legal business name
ADVANCED DENTAL CENTER, INC.
Practice address
1901 Rudy LN Ste 4
Louisville, KY 40207-1384
Phone
(502) 966-4367
NPI assigned
Aug 29, 2018
Organization subpart
Yes
Parent organization
ADVANCED DENTAL CENTER, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 11, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Rachel Talis, DMD
Title
President
Phone
(502) 966-4367

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 7118 KY Primary

Addresses

Primary practice location

1901 Rudy LN Ste 4
Louisville, KY 40207-1384

Mailing address

1901 Rudy LN Ste 4
Louisville, KY 40207-1384
Phone (502) 966-4367

Other identifiers 1

IdentifierTypeStateIssuer
61900353MedicaidKY

Other names 2

  • ADVANCED DENTAL CENTER Doing business as
  • ADVANCED DENTAL CENTER EAST Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Advanced Dental Center Brooks4 organizations share this tax ID, including this one
Part of
Advanced Dental Center Brooks

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1901 Rudy Ln
Ste 4
Louisville, KY 40207
Phone (502) 208-1516

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1535500800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1560211200000",
    "number": "1922580653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1901 RUDY LN STE 4",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402071384",
            "telephone_number": "502-966-4367"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1901 RUDY LN STE 4",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402071384",
            "telephone_number": "502-966-4367"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED DENTAL CENTER, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ADVANCED DENTAL CENTER, INC",
        "enumeration_date": "2018-08-29",
        "last_updated": "2019-06-11",
        "status": "A",
        "authorized_official_last_name": "TALIS",
        "authorized_official_first_name": "RACHEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "502-966-4367",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "KY",
            "license": "7118",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "61900353",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ADVANCED DENTAL CENTER",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "ADVANCED DENTAL CENTER EAST",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Louisville, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.