| NPI | 1720133879 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JON KELLY JOHNSON Dentist Direct Owner 859-498-7130 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: KY 7057) |
| Enumeration Date | 2007-01-25 |
| Last Update Date | 2011-09-26 |