| NPI | 1962773721 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATHY KENNEDY Office Mangaer 502-897-0625 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental (Licence: KY 4017) |
| Enumeration Date | 2012-01-25 |
| Last Update Date | 2012-01-25 |