| NPI | 1427349687 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY WILSON LOGAN Owner 502-429-0526 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: KY 5015) |
| Enumeration Date | 2011-04-22 |
| Last Update Date | 2011-04-22 |