| NPI | 1104657626 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMANDA GROESCHEL Director 704-978-9800 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2024-08-08 |
| Last Update Date | 2024-08-08 |