| NPI | 1275151292 |
|---|---|
| Doing Business As | PARK DUVALLE MOBILE DENTISTRY VAN |
| Entity Type | Organization |
| Authorized Contact | SWANNIE JETT CEO 502-774-4401 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2020-07-07 |
| Last Update Date | 2021-11-02 |