NPI | 1740776202 |
---|---|
Entity Type | Organization |
Authorized Contact | BRIDGET ANNE MULLEN Office Manager 307-690-1513 |
Organization Subpart ? | No |
Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery |
Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery |
Enumeration Date | 2018-07-09 |
Last Update Date | 2018-07-26 |