| NPI | 1124327200 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUSTIN C. CLEMENS Owner/Dentist 859-268-1596 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: KY 8167) |
| Enumeration Date | 2011-03-15 |
| Last Update Date | 2011-04-07 |