| NPI | 1558634808 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELISHA D SMITH Office Manager 270-745-0698 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: KY 4043) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY 4043) |
| Enumeration Date | 2012-02-17 |
| Last Update Date | 2012-02-17 |