Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Oral & Maxillofacial Surgery |
204E00000X | 02 | Physician/General Surgery |
| NPI Number | 1205664844 |
| LBN Legal business name | SUMMIT OREGON LLC |
| Authorized official | PRASHANT CHARUGUNDLA - (ORAL & MAXILLOFACIAL SURGEON) |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | 07/24/2024 |
| Last updated | 04/06/2026 - About 2 months ago |
| Identifiers | n/a |
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