| NPI | 1598883043 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PHILIP W MARCIANO President 239-513-1119 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery (Licence: FL ME 68618) |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2012-03-27 |