| NPI | 1851474563 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WAYNE E TIPPS Administrator 423-893-3333 |
| Organization Subpart ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2022-07-21 |