| NPI | 1235522277 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY LYNN HOLLAND Dentist/Owner 270-534-4887 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: KY 6765) |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies Customized Equipment |
| Enumeration Date | 2015-03-16 |
| Last Update Date | 2015-04-23 |