| NPI | 1942475934 |
|---|---|
| Doing Business As | FOURTH STREET DENTAL |
| Entity Type | Organization |
| Authorized Contact | THERESA C. HAYWARD President 502-585-4320 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: KY 8389) |
| Enumeration Date | 2008-04-29 |
| Last Update Date | 2008-04-29 |