Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Oral & Maxillofacial Surgery |
204E00000X | 02 | Physician/General Surgery |
| NPI Number | 1912790312 |
| LBN Legal business name | SCENIC CITY ORAL SURGERY, PLLC |
| Authorized official | CHARLES FELTS - (OWNER, SURGEON) |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | 05/28/2025 |
| Last updated | 05/28/2025 - More than a year ago |
| Identifiers | n/a |
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