| NPI | 1528166170 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SAMUEL GREGORY BENANTI Owner Pres Sole Shareholder 502-254-8745 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2020-08-22 |