| NPI | 1942750559 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERRY GRUELLE Owner 859-441-2369 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: KY 4118) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: KY 8737) |
| Enumeration Date | 2016-10-06 |
| Last Update Date | 2016-10-06 |