| NPI | 1336687045 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANTHONY GLEN WACH Owner 502-472-8423 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: PA DS038647) |
| Enumeration Date | 2017-02-02 |
| Last Update Date | 2017-02-02 |