| NPI | 1962162883 |
|---|---|
| Doing Business As | ST. PETERSBURG ORAL SURGERY |
| Entity Type | Organization |
| Authorized Contact | HILLARY THULL Credentialing Coordinator 217-540-8946 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Additional Taxonomies | 1223P0106X Dentist, Oral and Maxillofacial Pathology |
| Enumeration Date | 2021-12-20 |
| Last Update Date | 2022-07-20 |