| NPI | 1326535279 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MISTY C BLOMBERG Office Manager 522-509-6500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: FL Dn17708) |
| Enumeration Date | 2018-04-17 |
| Last Update Date | 2023-06-21 |