| NPI | 1114125267 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOANIE DE MAINE Credentialing Specialist 520-745-6531 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: AZ 2774) |
| 204E00000X Oral & Maxillofacial Surgery | |
| Enumeration Date | 2007-07-10 |
| Last Update Date | 2021-04-13 |