| NPI | 1194096115 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VICTOR S DEGEORGE Orthodontist 502-426-4868 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: KY 3550) |
| Enumeration Date | 2012-01-23 |
| Last Update Date | 2012-01-23 |