| NPI | 1083144992 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALICIA DUFFY Credentialing Manager 919-295-2757 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 122300000X Dentist |
| 1223E0200X Dentist, Endodontics | |
| 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: NC 4785) | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NC 4785) | |
| 1223P0300X Dentist, Periodontics (Licence: NC 4785) | |
| Enumeration Date | 2017-06-13 |
| Last Update Date | 2022-04-28 |