Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Oral & Maxillofacial Surgery |
204E00000X | 02 | Physician/General Surgery |
| NPI Number | 1790089886 |
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| LBN Legal business name | ORAL SURGERY SPECIALTY | ||||
| Authorized official | L. ISRAELSEN - (OWNER) | ||||
| Entity | Organization | ||||
| Organization subpart 1 | No | ||||
| Enumeration date | 01/04/2011 | ||||
| Last updated | 11/22/2011 - About 15 years ago | ||||
| Identifiers |
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ORAL SURGERY SPECIALTY
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