| NPI | 1588697015 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLENE ANN SCHMALTZ Practice Manager 7012-554-0000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery |
| Enumeration Date | 2006-07-08 |
| Last Update Date | 2020-08-22 |