| NPI | 1740808211 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIELLE BORUCH Insurance Administrator 402-421-3401 |
| Organization Subpart ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery |
| Enumeration Date | 2020-07-10 |
| Last Update Date | 2021-09-15 |