| NPI | 1962414680 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHAD CLIFTON STREET Owner 606-432-5983 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: KY 7103) |
| Enumeration Date | 2006-08-12 |
| Last Update Date | 2020-08-22 |