| NPI | 1356772677 |
|---|---|
| Doing Business As | MT STATE ORAL & MAXILLOFACIAL SURGE |
| Entity Type | Organization |
| Authorized Contact | LESLEY MARIE COYNER Credentialing 304-720-7819 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Enumeration Date | 2013-12-12 |
| Last Update Date | 2020-12-03 |