| NPI | 1205366846 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY SHIELDS Owner 502-409-4299 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: KY 9076) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: KY 9305) |
| Enumeration Date | 2017-06-15 |
| Last Update Date | 2017-06-15 |