| NPI | 1508408584 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW WEBER Partner 308-289-0290 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2019-10-11 |
| Last Update Date | 2019-10-11 |