| NPI | 1477720985 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FREDERICK GUSTAVE Owner/Oral Surgeon 618-529-2571 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS0112X Clinic/Center Oral and Maxillofacial Surgery (Licence: IL 019016600) |
| Enumeration Date | 2008-05-14 |
| Last Update Date | 2008-05-14 |