| NPI | 1144395468 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK R COWAN Dentist 336-249-2906 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NC NC2544) |
| Additional Taxonomies | 122300000X Dentist (Licence: NC NC6426) |
| Enumeration Date | 2006-11-21 |
| Last Update Date | 2020-08-22 |