| NPI | 1104469808 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SONYA MYRICK Director Of Cred. & Payor Relations 980-390-2807 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry |
| Enumeration Date | 2019-10-25 |
| Last Update Date | 2026-06-01 |