| NPI | 1972774099 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK THOMAS REAMS President 502-962-4442 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: KY 5542) |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental (Licence: KY 5542) |
| Enumeration Date | 2008-03-17 |
| Last Update Date | 2008-03-17 |