| NPI | 1548725765 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHEN ADAM TACKETT Orthodontist 606-523-2000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2019-02-01 |
| Last Update Date | 2019-02-01 |