Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Oral & Maxillofacial Surgery |
204E00000X | 02 | Physician/General Surgery |
| NPI # | 1972579183 |
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| LBN Legal business name | MAXILLOFACIAL SURGEONS, LTD. | ||||
| Authorized official | ANTHONY PETITO - (PRESIDENT) | ||||
| Entity | Organization | ||||
| Organization subpart 1 | No | ||||
| Enumeration date | 02/27/2006 | ||||
| Last updated | 08/22/2020 - About 6 years ago | ||||
| Identifiers |
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