| NPI | 1063468163 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRUCE V GALLUP President/Surgeon 207-514-7171 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Enumeration Date | 2006-05-26 |
| Last Update Date | 2012-07-10 |