| NPI | 1124556063 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALICIA M DUFFY Credentialing Manager 919-295-2757 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Additional Taxonomies | 1223G0001X Dentist, General Practice |
| 1223P0106X Dentist, Oral and Maxillofacial Pathology | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics | |
| Enumeration Date | 2017-05-23 |
| Last Update Date | 2022-05-04 |