| NPI | 1114103066 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK FRANKLIN KOZACKO President 919-848-9871 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Enumeration Date | 2008-01-10 |
| Last Update Date | 2008-02-25 |