| NPI | 1164430971 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL STERN President 307-739-8611 |
| Organization Subpart ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery |
| Enumeration Date | 2006-08-04 |
| Last Update Date | 2018-07-26 |