| NPI | 1205418258 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAUL LAVELLE Sole Member Of Dhda Provider Co P LLC 502-228-0234 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2021-04-28 |
| Last Update Date | 2021-04-28 |