| NPI | 1922521285 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MITCHELL HERNANDEZ Dentist/Owner 502-451-3931 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: KY 8817) |
| Enumeration Date | 2017-07-19 |
| Last Update Date | 2022-07-21 |