| NPI | 1477058659 |
|---|---|
| Doing Business As | SPARKLE AND SHINE FAMILY DENTAL |
| Entity Type | Organization |
| Authorized Contact | MITISHA MARTIN Owner 502-276-8778 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: KY 8651) |
| Additional Taxonomies | 261QD0000X Clinic/Center Dental (Licence: KY 8651) |
| Enumeration Date | 2018-03-28 |
| Last Update Date | 2018-08-01 |