| NPI | 1043870645 |
|---|---|
| Doing Business As | ST. PAUL ORAL SURGERY |
| Entity Type | Organization |
| Authorized Contact | CELIA HAYES Credentialing Coordinator 217-540-2100 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Enumeration Date | 2019-06-17 |
| Last Update Date | 2022-05-02 |