NPI | 1003388117 |
---|---|
Doing Business As | MT STATE ORAL & FACIAL SURGERY |
Entity Type | Organization |
Authorized Contact | LESLEY MARIE COYNER Credentialing 304-345-1092 |
Organization Subpart ? | No |
Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery |
Enumeration Date | 2018-12-31 |
Last Update Date | 2020-12-03 |