| NPI | 1306623111 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RUTH BERENSTEIN Mng Director 502-686-0096 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Enumeration Date | 2023-09-14 |
| Last Update Date | 2023-09-14 |