NPI | 1407109937 |
---|---|
Doing Business As | PROVIDENCE MEDICAL GROUP |
Doing Business As | PROVIDENCE ORAL HEAD AND NECK CLINIC |
Entity Type | Organization |
Authorized Contact | DONALD WAYNE ANDERSON Assistant Secretary Enrollment 425-358-9786 |
Organization Subpart ? | No |
Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery |
Additional Taxonomies | 261Q00000X Clinic/Center |
Enumeration Date | 2012-10-22 |
Last Update Date | 2025-07-04 |