| NPI | 1174393060 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEVEN MICHAEL CUDNEY Owner/Employee 269-615-6987 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery |
| Enumeration Date | 2024-01-03 |
| Last Update Date | 2024-01-03 |