| NPI | 1114816105 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATIE TUNDER Billing Manager 877-667-7669 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Enumeration Date | 2025-07-02 |
| Last Update Date | 2025-07-02 |