| NPI | 1083336564 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFF COHEN COO 704-246-8971 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics |
| Additional Taxonomies | 1223P0221X Dentist Pediatric Dentistry |
| Enumeration Date | 2022-09-13 |
| Last Update Date | 2022-11-17 |