| NPI | 1174732572 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRIS JAY AUGUSTINE Chief Executive Officer 920-405-5382 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2022-04-13 |