| NPI | 1588131528 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES ALVIN MAXWELL Owner 937-399-4476 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery |
| Enumeration Date | 2018-10-29 |
| Last Update Date | 2018-10-29 |