Provider Demographics
NPI:1932913365
Name:KENTUCKIANA BIODENT
Entity type:Organization
Organization Name:KENTUCKIANA BIODENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:812-285-1781
Mailing Address - Street 1:405 E COURT AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-3474
Mailing Address - Country:US
Mailing Address - Phone:812-285-1781
Mailing Address - Fax:812-291-5609
Practice Address - Street 1:405 E COURT AVE STE 110
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-3474
Practice Address - Country:US
Practice Address - Phone:812-285-1781
Practice Address - Fax:812-291-5609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-05
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty