Provider Demographics
NPI:1174323042
Name:AESTHETIC AND WELLNESS DENTAL PLLC
Entity type:Organization
Organization Name:AESTHETIC AND WELLNESS DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDSEY
Authorized Official - Middle Name:NICHOLE
Authorized Official - Last Name:GRAVES
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:502-693-5685
Mailing Address - Street 1:11900 SHELBYVILLE RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40243-1041
Mailing Address - Country:US
Mailing Address - Phone:502-244-0333
Mailing Address - Fax:502-245-8142
Practice Address - Street 1:11900 SHELBYVILLE RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40243-1041
Practice Address - Country:US
Practice Address - Phone:502-244-0333
Practice Address - Fax:502-245-8142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-18
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental