Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Oral & Maxillofacial Surgery |
204E00000X | 02 | Physician/General Surgery |
| NPI Number | 1245697432 |
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| LBN Legal business name | MIDDLETOWN ORAL SURGERY ASSOCIATES, P.C. | ||||
| Authorized official | EDWARD KOZLOVSKY - (OWNER) | ||||
| Entity | Organization | ||||
| Organization subpart 1 | No | ||||
| Enumeration date | 01/20/2016 | ||||
| Last updated | 04/08/2016 - About 10 years ago | ||||
| Identifiers |
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