| NPI | 1396737011 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NATHAN F WALTERS President 502-454-4885 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Additional Taxonomies | 122300000X Dentist |
| 204E00000X Oral & Maxillofacial Surgery | |
| Enumeration Date | 2005-08-18 |
| Last Update Date | 2018-02-06 |