| NPI | 1306220140 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GLENN R. BLINCOE President 502-895-2210 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies Customized Equipment |
| Enumeration Date | 2015-07-10 |
| Last Update Date | 2016-12-22 |