Individual
GRACEN LEE FISTLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2441 21ST ST, FORT CAMPBELL, KY 42223-5582
(270) 798-8751
Mailing address
2441 21ST ST, FORT CAMPBELL, KY 42223-5582
(270) 798-8751
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
10644
KY
Other
Enumeration date
06/11/2021
Last updated
06/11/2021
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