| NPI | 1659538155 |
|---|---|
| Doing Business As | STATELINE ORAL & MAXILLOFACIAL SURGERY, P.C. |
| Entity Type | Organization |
| Authorized Contact | TIMOTHY M. LAWRENCDE President 419-473-2707 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: OH 30-16301) |
| Enumeration Date | 2008-05-21 |
| Last Update Date | 2008-05-21 |