| NPI | 1831863737 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PHI LE Credentialing Contracts Manager 267-575-2321 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223P0106X Dentist, Oral and Maxillofacial Pathology |
| Enumeration Date | 2021-08-04 |
| Last Update Date | 2021-08-04 |