NPI | 1023616034 |
---|---|
Entity Type | Organization |
Authorized Contact | SUSAN STEGMAN Credentialing Co Ordinator 719-599-0500 |
Organization Subpart ? | Yes |
Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
Enumeration Date | 2020-10-12 |
Last Update Date | 2020-10-12 |