| NPI | 1861124646 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RAVI CHANDRAN Owner 601-208-9064 |
| Organization Subpart ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Enumeration Date | 2022-06-29 |
| Last Update Date | 2022-07-01 |