| NPI | 1093077166 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL LEE BOBO Partner/ Member 270-759-4063 |
| Organization Subpart ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: TN 30866) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: KY 7465) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: KY 8841) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TN 7404) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TN 8334) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: KY 34759) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: KY 8841) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: TN 8334) | |
| Enumeration Date | 2012-06-13 |
| Last Update Date | 2012-07-11 |