| 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 |