| NPI | 1609649177 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK MCILWAIN Owner/ Oral Surgeon 256-712-5096 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery |
| Enumeration Date | 2023-11-06 |
| Last Update Date | 2024-02-09 |