| NPI | 1740533892 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FRANK FARBOD Medical Director 906-225-5959 |
| Organization Subpart ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| 2082S0099X Plastic Surgery, Plastic Surgery Within the Head and Neck | |
| 261QA1903X Clinic/Center, Ambulatory Surgical | |
| Enumeration Date | 2012-10-25 |
| Last Update Date | 2020-09-08 |