| NPI | 1427740794 |
|---|---|
| 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 | 2023-05-24 |
| Last Update Date | 2023-06-20 |