| NPI | 1710052998 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SALLY R. WILLIS President 502-231-9970 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: KY 5032) |
| Enumeration Date | 2006-11-22 |
| Last Update Date | 2020-08-22 |