| NPI | 1861807646 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STONE RANGARAJAN THAYER President 386-837-1236 |
| Organization Subpart ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: FL ME 114524) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: FL DN 20469) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: FL DN 13469) | |
| 124Q00000X Dental Hygienist (Licence: FL DH 17491) | |
| 2082S0099X Plastic Surgery, Plastic Surgery Within the Head and Neck (Licence: FL ME 114524) | |
| Enumeration Date | 2014-06-30 |
| Last Update Date | 2014-06-30 |