| NPI | 1124070222 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES M WALTER Owner 336-768-9881 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NC 4128) |
| Additional Taxonomies | 1223P0106X Dentist, Oral and Maxillofacial Pathology |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NC 7036) | |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2012-11-14 |