| NPI | 1265972137 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RONNIE DOUGLAS ELLIOTT Doctor 859-282-1632 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: KY 7616) |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Enumeration Date | 2017-02-27 |
| Last Update Date | 2019-06-25 |