| NPI | 1205910163 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES W. TINGLE President 606-784-4340 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: KY 4246) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY 4246) |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2015-09-03 |