| NPI | 1326730821 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRADLEY ALLEN ELI CEO 844-235-9881 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Additional Taxonomies | 1223X2210X Dentist, Orofacial Pain |
| Enumeration Date | 2023-05-23 |
| Last Update Date | 2023-08-24 |