Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Oral & Maxillofacial Surgery |
204E00000X | 02 | Physician/General Surgery | |
Otology & Neurotology |
207YX0901X | 04 | Physician/Otolaryngology |
| NPI Number | 1821153941 |
||||
| LBN Legal business name | HEAD & NECK SURGICAL ASSOCIATES, PC | ||||
| Authorized official | SHANNON GRESH - (CLINIC OPERATIONS MANAGER) | ||||
| Entity | Organization | ||||
| Organization subpart 1 | No | ||||
| Enumeration date | 12/27/2006 | ||||
| Last updated | 05/21/2021 - About 5 years ago | ||||
| Identifiers |
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