| NPI | 1063557932 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DOUGLAS LANE FOWLER Owner 910-790-3836 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 5355) |
| Enumeration Date | 2007-02-20 |
| Last Update Date | 2020-08-22 |