| NPI | 1114380698 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SCOTT RISSMILLER Enterprise EVP 704-355-8675 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 1223P0300X Dentist Periodontics |
| 1223S0112X Dentist Oral and Maxillofacial Surgery | |
| Enumeration Date | 2016-04-01 |
| Last Update Date | 2023-03-09 |