| NPI | 1891105532 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEVIN MOSHER Chief Executive Officer 888-651-9950 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WA 00004170) |
| Enumeration Date | 2014-05-03 |
| Last Update Date | 2014-05-03 |