| NPI | 1871724914 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM DOUGLAS SHAVER Owner 270-926-6100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: KY 4637) |
| Enumeration Date | 2009-08-06 |
| Last Update Date | 2009-08-06 |