| NPI | 1275251118 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ARYN SHERFIELD Credentialing 877-667-7669 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery |
| Additional Taxonomies | 261Q00000X |
| Enumeration Date | 2022-08-17 |
| Last Update Date | 2022-10-21 |