| NPI | 1174912224 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUSTIN MICHAEL RAYBOULD President/CEO 859-321-7051 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: KY 8732) |
| Enumeration Date | 2015-01-13 |
| Last Update Date | 2015-04-13 |