| NPI | 1538605696 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WHITNEY LEANNE WILSON President/Owner/Dentist 502-592-4404 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TN 9659) |
| Enumeration Date | 2017-01-13 |
| Last Update Date | 2017-01-13 |