| NPI | 1104096502 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON NELSEN Managing Member 704-392-8199 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 7540) |
| Enumeration Date | 2008-03-03 |
| Last Update Date | 2008-03-03 |