Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Oral & Maxillofacial Surgery |
204E00000X | 02 | Physician/General Surgery |
| NPI Number | 1700388592 |
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| LBN Legal business name | DENTAL MANAGEMENT GROUP LLC | ||||
| Authorized official | YASSER SEDHOM - (BUSINESS DIRECTOR) | ||||
| Entity | Organization | ||||
| Organization subpart 1 | Yes | ||||
| Enumeration date | 03/07/2018 | ||||
| Last updated | 05/09/2023 - About 3 years ago | ||||
| Identifiers |
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