| NPI | 1558891275 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSICA HANCOCK RENAKER Dentist 270-791-7101 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental (Licence: KY 8890) |
| Enumeration Date | 2017-06-14 |
| Last Update Date | 2017-06-14 |