| NPI | 1093758476 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRADLEY AUSTIN SAMUEL Owner 336-883-2316 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 0546) |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2023-03-01 |