| NPI | 1982058590 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY J SHUTT Insurance Coordinator 270-554-2026 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Enumeration Date | 2016-04-20 |
| Last Update Date | 2016-04-20 |