| NPI | 1164502522 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH J SMITH President 606-784-8983 |
| Organization Subpart ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery |
| Additional Taxonomies | 122300000X Dentist |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2025-09-11 |