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 |