| NPI | 1306235619 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RANDON SCOTT PRATHER President 270-527-1479 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: KY 9492) |
| Enumeration Date | 2015-01-11 |
| Last Update Date | 2015-01-11 |