| NPI | 1376973818 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JILL ELIZABETH KEATON Sole Member 606-437-7609 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental (Licence: KY 6470) |
| Enumeration Date | 2013-11-20 |
| Last Update Date | 2015-10-13 |