| NPI | 1093895864 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | G. PHILIP WHITESIDE President 270-651-6471 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: KY 075651) |
| Enumeration Date | 2006-10-16 |
| Last Update Date | 2020-08-22 |