| NPI | 1366882524 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JANELLE PICKLESIMER Credentialing Specialist 502-254-8500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2013-07-02 |
| Last Update Date | 2013-07-02 |