is a Oral And Maxillofacial Surgery in , . practices all healthcare services and medical treatments related to Oral And Maxillofacial Surgery. The NPI Number for is 1598876260. The last update date is .
's current location address is , , . You can contact this provider via phone number . The mailing address for is , , . To know further, please read the information below!
Provider Profile Detail
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| Address | , , |
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| Sole Proprietor | -- |
| Credentials | -- |
NPI Number Detail
| NPI Number | 1598876260 |
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Provider Mailing Address Detail
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| State | () |
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Provider's Primary Taxonomy Detail
| Speciality | Oral And Maxillofacial Surgery |
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| Taxonomy | 1223S0112X |
| Licence No | 13241 |
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Definition: The specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. |
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Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
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| 250724 | MA | -- |
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