| NPI | 1972782407 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH WAYNE LIVESAY Oral Surgeon 502-254-3818 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery |
| Enumeration Date | 2007-11-01 |
| Last Update Date | 2019-12-12 |