| NPI | 1720423197 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARC LEWIS MARLETTE Owner 859-283-1055 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: KY 7299) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY 7299) |
| Enumeration Date | 2013-04-30 |
| Last Update Date | 2014-04-30 |