| NPI | 1154627230 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACK TYLER WINCHESTER Owner 252-247-3510 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NC 5372) |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment (Licence: NC 5372) |
| Enumeration Date | 2011-02-07 |
| Last Update Date | 2011-02-07 |