| NPI | 1407298102 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BENNIE ALDERDICE Owner 606-679-8568 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Additional Taxonomies | 122300000X Dentist (Licence: KY 4939) |
| Enumeration Date | 2013-07-23 |
| Last Update Date | 2013-07-23 |