| NPI | 1689024465 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONALD SCOTT BRIDGES Member 270-519-7342 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: KY 7956) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY 7956) |
| Enumeration Date | 2016-06-13 |
| Last Update Date | 2016-06-13 |