| NPI | 1821107442 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RANDY H ELLIOTT Doctor Owner 270-782-0716 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: KY 7717) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: KY 7232) |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2020-08-22 |