| NPI | 1649762428 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ARTHUR WICKSON President 502-386-0657 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: KY 6987) |
| Enumeration Date | 2018-06-06 |
| Last Update Date | 2018-06-06 |