| NPI | 1184827446 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIEL GARDNER BOEH President 270-554-1324 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: KY 3752) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY 222) |
| Enumeration Date | 2007-06-06 |
| Last Update Date | 2020-08-22 |