| NPI | 1457886376 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMIE M SHROUT Office Manager 502-226-6700 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: KY 8371) |
| Enumeration Date | 2017-04-28 |
| Last Update Date | 2017-04-28 |