| NPI | 1992766737 |
|---|---|
| Other Name | MT. STATE ORAL & MAXILLOFACIAL SURGEONS |
| Entity Type | Organization |
| Authorized Contact | LESLEY MARIE COYNER Credentialing 304-720-7819 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Enumeration Date | 2006-03-31 |
| Last Update Date | 2020-12-03 |