| NPI | 1568557114 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY W FISK President 606-451-1448 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: KY 7491) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2020-08-22 |