| NPI | 1003115940 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID MCDONALD CFO 502-596-1039 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental (Licence: KY 740143) |
| Enumeration Date | 2011-03-17 |
| Last Update Date | 2023-08-03 |