| NPI | 1306835632 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FRED LOOK President 502-448-7988 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: KY 3880) |
| Enumeration Date | 2005-10-19 |
| Last Update Date | 2020-08-22 |