| NPI | 1790969459 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GREGORY PAUL VANNUCCI President 641-682-2350 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: IA 07963) |
| Enumeration Date | 2007-12-18 |
| Last Update Date | 2007-12-18 |