| NPI | 1952532665 |
|---|---|
| Doing Business As | CHILDREN AND YOUTH DENTAL CLINIC |
| Entity Type | Organization |
| Authorized Contact | LEE ANN MINGUS Insurance Billing Manager 502-852-5588 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental |
| Enumeration Date | 2009-07-29 |
| Last Update Date | 2011-09-02 |