| NPI | 1720009061 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEBBIE L. CLARK Office Manager 502-897-9417 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: KY 4036) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: IN 8228) |
| 1223P0300X Dentist, Periodontics (Licence: KY 5446) | |
| 1223P0300X Dentist, Periodontics (Licence: IN 8270) | |
| 1223P0300X Dentist, Periodontics (Licence: KY 8517) | |
| 1223P0300X Dentist, Periodontics (Licence: IN 12011213A) | |
| Enumeration Date | 2006-07-22 |
| Last Update Date | 2010-08-04 |