| NPI | 1134540347 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES M WALTER President 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 (Licence: NC 4128) |
| 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: NC 9605) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NC 9605) | |
| Enumeration Date | 2013-12-16 |
| Last Update Date | 2013-12-16 |