| NPI | 1649039967 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON BRODY Credentialing Manager 267-494-1483 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Enumeration Date | 2024-03-18 |
| Last Update Date | 2025-01-24 |