| NPI | 1538380662 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHEN MARK SHALL President 419-479-3939 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS0112X Clinic/Center Oral and Maxillofacial Surgery |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2019-07-31 |