| NPI | 1093887937 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRET A AVRA President 270-443-1717 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: KY 6283) |
| Enumeration Date | 2006-11-15 |
| Last Update Date | 2020-08-22 |