| NPI | 1356407258 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PHILLIP T LATHAM President Surgeon 6141-878-7778 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Enumeration Date | 2006-12-28 |
| Last Update Date | 2020-08-22 |