Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Oral & Maxillofacial Surgery |
204E00000X | 02 | Physician/General Surgery |
| NPI Number | 1538327655 |
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| LBN Legal business name | ORAL & MAXILLOFACIAL SURGERY ASSOC PC | ||||||||
| Authorized official | THEODORE 'TED' GEORGE - (ORAL SURGEON VICE PRESIDENT) | ||||||||
| Entity | Organization | ||||||||
| Organization subpart 1 | No | ||||||||
| Enumeration date | 05/27/2008 | ||||||||
| Last updated | 05/29/2019 - About 7 years ago | ||||||||
| Identifiers |
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