Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Oral & Maxillofacial Surgery |
204E00000X | 02 | Physician/General Surgery |
| NPI Number | 1306214200 |
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| LBN Legal business name | LISA MILLER ORAL FACIAL SURGERY | ||||
| Authorized official | LISA MILLER - (ORAL SURGEON) | ||||
| Entity | Organization | ||||
| Organization subpart 1 | No | ||||
| Enumeration date | 09/09/2015 | ||||
| Last updated | 06/11/2021 - About 5 years ago | ||||
| Identifiers |
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