| NPI | 1235234311 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VICKI W PAUL Administrative Assistant 270-765-5597 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: KY 6034) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: KS 6004) |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2020-08-22 |