| NPI | 1275292377 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH W LIVESAY Member 502-897-5282 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery |
| Enumeration Date | 2021-12-16 |
| Last Update Date | 2023-08-14 |