| NPI | 1033397914 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY REIBEL Chief Financial Officer 502-254-8526 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| 207L00000X Anesthesiology | |
| Enumeration Date | 2008-02-04 |
| Last Update Date | 2024-08-02 |