Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Oral & Maxillofacial Surgery |
204E00000X | 02 | Physician/General Surgery |
| NPI # | 1851644694 |
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| LBN Legal business name | LESLIE ROBERT FISH DDS PC | ||||
| Authorized official | LESLIE FISH - (OWNER) | ||||
| Entity | Organization | ||||
| Organization subpart 1 | No | ||||
| Enumeration date | 10/17/2012 | ||||
| Last updated | 10/17/2012 - About 14 years ago | ||||
| Identifiers |
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