| NPI | 1568985349 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICHARD CORDERO Owner/ Surgeon 251-333-1700 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery (Licence: AL 6357) |
| Enumeration Date | 2017-07-24 |
| Last Update Date | 2022-07-21 |