| NPI | 1821721473 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AARON WALLENDER Owner 859-907-5882 |
| Organization Subpart ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Enumeration Date | 2022-07-01 |
| Last Update Date | 2025-10-07 |