| NPI | 1104511823 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMEKA KNIGHT Associate 251-564-4365 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry |
| Enumeration Date | 2023-04-07 |
| Last Update Date | 2023-04-07 |