| NPI | 1144679507 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHANIE LYNN JACKSON Pediatric Dentist 919-412-4199 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry |
| Enumeration Date | 2016-06-07 |
| Last Update Date | 2016-08-03 |