Provider Demographics
NPI:1255720132
Name:AESTHETIC LDP PLLC
Entity type:Organization
Organization Name:AESTHETIC LDP PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MUAINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-633-4219
Mailing Address - Street 1:2304 MIDWAY RD
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-1611
Mailing Address - Country:US
Mailing Address - Phone:972-473-8880
Mailing Address - Fax:972-473-8882
Practice Address - Street 1:2304 MIDWAY RD
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-1611
Practice Address - Country:US
Practice Address - Phone:972-473-8880
Practice Address - Fax:972-473-8882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-15
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty