| NPI | 1477861888 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LESLIE ANN KAUFMAN Credentialing/Contract Specialist 502-596-1048 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Additional Taxonomies | 261QM2500X Clinic/Center, Medical Specialty (Licence: KY 740143) |
| Enumeration Date | 2010-09-20 |
| Last Update Date | 2025-05-15 |