| NPI | 1568768224 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFF REIBEL CFO 502-254-8500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: KY 7229) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: KY 3498) |
| 261QD0000X Clinic/Center, Dental | |
| Enumeration Date | 2011-01-28 |
| Last Update Date | 2023-09-06 |