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 |