| NPI | 1841392859 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BARRY C SHAFFER President 606-836-8162 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: KY 4635) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: KY 4636) |
| Enumeration Date | 2006-09-01 |
| Last Update Date | 2020-08-22 |