| NPI | 1720712938 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES W VITTITOW Owner 502-523-3514 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2022-07-13 |
| Last Update Date | 2022-08-12 |