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Individual
JACOB WILLIAM BUSTER MENDENHALL
Active
Individual
JACOB WILLIAM BUSTER MENDENHALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
148
OK
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
5823
OK
Other
Enumeration date
02/14/2007
Last updated
12/08/2010
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