| NPI | 1093294076 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACOB R. LONG Dentist/Owner 910-762-0355 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: NC 10411) |
| Enumeration Date | 2018-08-09 |
| Last Update Date | 2018-08-09 |