| NPI | 1871715300 |
|---|---|
| Doing Business As | DR. MARY T. EWALD |
| Entity Type | Organization |
| Authorized Contact | MARY TYLER EWALD Dentist 502-361-1872 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: KY 5271) |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2020-08-22 |