| NPI | 1952648388 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PHI LE Credentialing Specialist 267-460-4254 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Enumeration Date | 2013-01-04 |
| Last Update Date | 2013-01-04 |