| NPI | 1063508398 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LESLIE LISETTE BAECHTOLD Dentist 859-626-7977 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: KY 6635) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY 6635) |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2009-07-28 |