| NPI | 1831631563 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KAITLIN ELIZABETH BLACKBURN Dentist 812-306-4451 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN21161) |
| Enumeration Date | 2016-11-11 |
| Last Update Date | 2016-11-11 |