Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Oral & Maxillofacial Surgery |
204E00000X | 02 | Physician/General Surgery | |
Endodontics |
1223E0200X | |||
Oral and Maxillofacial Surgery |
1223S0112X | 19 | Oral Surgery (Dentist only) |
| NPI Number | 1316954928 |
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| LBN Legal business name | ORAL AND MAXILLOFACIAL SURGERY ASSO OF EAU CLAIRE SC | ||||||||||||||||||||||||
| Authorized official | GINA THOR - (TRANSCRIPTION AND CREDENTIALING) | ||||||||||||||||||||||||
| Entity | Organization | ||||||||||||||||||||||||
| Organization subpart 1 | No | ||||||||||||||||||||||||
| Enumeration date | 08/03/2006 | ||||||||||||||||||||||||
| Last updated | 07/26/2018 - About 8 years ago | ||||||||||||||||||||||||
| Identifiers |
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