| NPI | 1891298337 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLE EISENBERG Owner 865-410-3075 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery |
| Enumeration Date | 2018-03-12 |
| Last Update Date | 2018-10-24 |