| NPI | 1417328162 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CANDY EBBIGHAUSEN Administrator 603-357-3709 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Enumeration Date | 2015-10-07 |
| Last Update Date | 2022-12-15 |