Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Oral & Maxillofacial Surgery |
204E00000X | 02 | Physician/General Surgery |
| NPI # | 1477679157 |
| LBN Legal business name | FACIAL & ORAL SURGERY, LLC. |
| Authorized official | GORDON CASS - (CHIEF OPERATING OFFICER) |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | 03/22/2007 |
| Last updated | 08/22/2020 - About 6 years ago |
| Identifiers | n/a |
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