| NPI | 1144621996 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DELIA RITTER Credentialing Manager 502-244-2441 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 124Q00000X Dental Hygienist |
| Enumeration Date | 2014-09-11 |
| Last Update Date | 2017-02-02 |