Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Oral & Maxillofacial Surgery |
204E00000X | 02 | Physician/General Surgery |
| NPI Number | 1851474563 |
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| LBN Legal business name | ASSOCIATES IN ORAL AND MAXILLOFACIAL SURGERY, P. C. | ||||
| Authorized official | WAYNE TIPPS - (ADMINISTRATOR) | ||||
| Entity | Organization | ||||
| Organization subpart 1 | No | ||||
| Enumeration date | 10/24/2006 | ||||
| Last updated | 07/21/2022 - About 4 years ago | ||||
| Identifiers |
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