| NPI | 1992718340 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MANDY WALLIN Office Manager 859-223-4644 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: KY 55800) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY 8009) |
| Enumeration Date | 2006-08-15 |
| Last Update Date | 2018-05-09 |