| NPI | 1902333131 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTEN THOM Billing 412-965-0031 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery |
| Additional Taxonomies | 261QA1903X Clinic/Center, Ambulatory Surgical |
| Enumeration Date | 2017-05-18 |
| Last Update Date | 2017-05-18 |