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NPI Profile for SAN TAN VALLEY ORAL FACIAL AND IMPLANT SURGERY PLLC in SAN TAN VALLEY, AZ.
Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Oral & Maxillofacial Surgery |
204E00000X | 02 | Physician/General Surgery |
| NPI # | 1629546171 |
|
| Status | Active | |
| Credentials | ||
| Entity | Individual | |
| Enumeration date | 11/02/2018 | |
| Last updated | 11/02/2018 - About 8 years ago | |
| Sole proprietor 1 | Not specified | |
| Identifiers | Not Available | |
| Hospital affiliation(s) | Not Available |
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SAN TAN VALLEY ORAL FACIAL AND IMPLANT SURGERY PLLC