| NPI | 1134448566 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JULIE LYNN SANDIFER Consultant 502-319-3144 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: KY 7403) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: KY 8809) |
| Enumeration Date | 2010-05-25 |
| Last Update Date | 2010-05-25 |