| NPI | 1891201430 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOY L PAYNE Credentialing Manager 502-244-2441 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2017-12-19 |
| Last Update Date | 2018-02-16 |