| NPI | 1942327077 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATT CASSIDY President 502-587-8839 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: KY 8224) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: KY 4046) |
| Enumeration Date | 2007-03-23 |
| Last Update Date | 2020-08-22 |