| NPI | 1053561779 |
|---|---|
| Doing Business As | MT STATE ORAL & MAXILLOFACIAL SURGEONS |
| Entity Type | Organization |
| Authorized Contact | LESLEY MARIE COYNER Credentialing 304-720-7819 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Enumeration Date | 2008-09-30 |
| Last Update Date | 2020-12-03 |