Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Oral & Maxillofacial Surgery |
204E00000X | 02 | Physician/General Surgery |
| NPI Number | 1104587708 |
| LBN Legal business name | EVEREST PC |
| Authorized official | ERON ALDRIDGE - (ORAL SURGEON) |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | 01/05/2022 |
| Last updated | 01/05/2022 - About 4 years ago |
| Identifiers | n/a |
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