| NPI | 1831694314 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELAINE A JOHNSON Office Manager/Spouse 502-448-0678 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: KY 5700) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: KY 9805) |
| Enumeration Date | 2018-03-27 |
| Last Update Date | 2018-03-27 |