| NPI | 1790171221 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOY L STEVENS Director Of Revenue 502-244-2441 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: TX 25128) |
| Enumeration Date | 2015-04-10 |
| Last Update Date | 2025-07-17 |