| NPI | 1528568789 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GARY PHILLIP WALDEN Owner 270-563-4819 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: KY 9168) |
| Enumeration Date | 2018-02-14 |
| Last Update Date | 2018-02-14 |