| NPI | 1851821854 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUSTIN MICHAEL RAYBOULD Manager 859-321-7051 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: KY 8778) |
| Additional Taxonomies | 1223P0221X Dentist Pediatric Dentistry (Licence: KY 8732) |
| Enumeration Date | 2017-06-13 |
| Last Update Date | 2022-07-21 |