| NPI | 1790167500 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIFFANY JEAN RILEY General Dentist 270-205-8197 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: KY 8378) |
| Enumeration Date | 2015-06-29 |
| Last Update Date | 2015-06-29 |