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NPI Profile for PROVIDENCE ORAL SURGERY AND DENTAL IMPLANT CENTER in WAXHAW, NC.
The specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region.
Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Oral and Maxillofacial Surgery |
1223S0112X | 19 | Oral Surgery (Dentist only) | |
Oral and Maxillofacial Surgery |
261QS0112X |
| NPI # | 1912468463 |
|
| Status | Active | |
| Credentials | ||
| Entity | Individual | |
| Enumeration date | 03/27/2019 | |
| Last updated | 10/26/2021 - About 5 years ago | |
| Sole proprietor 1 | Not specified | |
| Identifiers | Not Available | |
| Hospital affiliation(s) | Not Available |
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PROVIDENCE ORAL SURGERY AND DENTAL IMPLANT CENTER
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PROVIDENCE ORAL SURGERY AND DENTAL IMPLANT CENTER