| NPI | 1477707784 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES T NUCKOLS Owner 270-843-4341 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: KY 3399) |
| Enumeration Date | 2008-11-13 |
| Last Update Date | 2008-11-13 |