Provider Demographics
NPI:1730364761
Name:ALBERT E BATHIANY IV DMD
Entity type:Organization
Organization Name:ALBERT E BATHIANY IV DMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:BATHIANY
Authorized Official - Suffix:IV
Authorized Official - Credentials:DMD
Authorized Official - Phone:859-781-4100
Mailing Address - Street 1:18 N FORT THOMAS AVE
Mailing Address - Street 2:
Mailing Address - City:FORT THOMAS
Mailing Address - State:KY
Mailing Address - Zip Code:41075-3098
Mailing Address - Country:US
Mailing Address - Phone:859-781-4100
Mailing Address - Fax:859-781-0170
Practice Address - Street 1:18 N FORT THOMAS AVE
Practice Address - Street 2:
Practice Address - City:FORT THOMAS
Practice Address - State:KY
Practice Address - Zip Code:41075-3098
Practice Address - Country:US
Practice Address - Phone:859-781-4100
Practice Address - Fax:859-781-0170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-09
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY61941787Medicaid