| NPI | 1124517719 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY DAVIS Practice Manager 910-383-2615 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 8379) |
| Enumeration Date | 2018-05-09 |
| Last Update Date | 2018-05-09 |