| NPI | 1477639243 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERESA BENTLEY Physician/Owner 606-679-9292 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology |
| Additional Taxonomies | 207ND0101X Dermatology MOHS-Micrographic Surgery |
| 207ND0900X Dermatology Dermatopathology | |
| 207NI0002X Dermatology Clinical & Laboratory Dermatological Immunology | |
| 363AM0700X Physician Assistant Medical | |
| Enumeration Date | 2006-10-27 |
| Last Update Date | 2013-03-11 |