| NPI | 1003644436 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VIRGINIA JONES CEO 910-992-2066 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics |
| 1223P0221X Dentist, Pediatric Dentistry | |
| 207L00000X Anesthesiology | |
| 208600000X Surgery | |
| 261QD0000X Clinic/Center, Dental | |
| Enumeration Date | 2024-07-25 |
| Last Update Date | 2024-07-25 |