| NPI | 1154336642 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALICIA DUFFY Credentialing Manager 919-292-2757 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 4785) |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2023-12-11 |