| NPI | 1699819136 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GREGORY BRYAN FORT Senior Dentist 270-782-1128 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: KY 5683) |
| Enumeration Date | 2007-02-17 |
| Last Update Date | 2020-08-22 |