Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Oral & Maxillofacial Surgery |
204E00000X | 02 | Physician/General Surgery |
| NPI # | 1316151798 |
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| LBN Legal business name | CAPITOL CENTER FOR ORAL & MAXILLOFACIAL SURGERY, PLLC | ||||||||||||||||
| Authorized official | RICHARD ROSATO - (OWNER) | ||||||||||||||||
| Entity | Organization | ||||||||||||||||
| Organization subpart 1 | No | ||||||||||||||||
| Enumeration date | 05/09/2007 | ||||||||||||||||
| Last updated | 08/14/2012 - About 14 years ago | ||||||||||||||||
| Identifiers |
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