| NPI | 1205259702 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFF REIBEL CFO 502-254-8526 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Additional Taxonomies | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2014-02-04 |
| Last Update Date | 2023-03-01 |