Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Oral & Maxillofacial Surgery |
204E00000X | 02 | Physician/General Surgery |
| NPI Number | 1366701450 |
| LBN Legal business name | SHELBY ORAL FACIAL SURGERY PC |
| Authorized official | NICHOLAS LIVINGSTON - (MEMBER) |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | 05/09/2012 |
| Last updated | 05/09/2012 - About 14 years ago |
| Identifiers | n/a |
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