| NPI | 1164914982 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGELIKA ROE Credentialing 888-247-1869 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS0112X Clinic/Center Oral and Maxillofacial Surgery |
| Enumeration Date | 2018-06-06 |
| Last Update Date | 2018-06-06 |