| NPI | 1053767053 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTA PAUL Financial Coordinator 606-878-1971 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: KY 6224) |
| Enumeration Date | 2016-05-09 |
| Last Update Date | 2016-05-09 |