Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Oral & Maxillofacial Surgery |
204E00000X | 02 | Physician/General Surgery |
| NPI # | 1942057583 |
| LBN Legal business name | BUCKEYE DENTAL IMPLANTS & ORAL SURGERY |
| Authorized official | HARRISON FRYBERG - (OWNER) |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | 05/01/2024 |
| Last updated | 10/15/2025 - About 8 months ago |
| Identifiers | n/a |
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