NPI | 1215071394 |
---|---|
Entity Type | Organization |
Authorized Contact | LYELL R. HOGG Owner 641-424-1656 |
Organization Subpart ? | No |
Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: IA 07778) |
Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
204E00000X Oral & Maxillofacial Surgery (Licence: IA 08489) | |
Enumeration Date | 2007-02-20 |
Last Update Date | 2018-01-04 |