| NPI | 1487074704 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGIE ROE Credentialing And Contracting 888-247-1869 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Enumeration Date | 2014-04-25 |
| Last Update Date | 2018-03-17 |