| NPI | 1215446042 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KAMI JO GANUS Revenue Cycle Manager 907-865-5254 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Enumeration Date | 2017-09-25 |
| Last Update Date | 2022-07-21 |