| NPI | 1811310626 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT AUNDRA SKILES Dentist 502-635-5004 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: KY 5072) |
| Enumeration Date | 2014-01-30 |
| Last Update Date | 2014-01-30 |