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 |