| NPI | 1194231340 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELISE MICHELLE NEWSOME President 336-274-6073 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: NC 9021) |
| Enumeration Date | 2017-12-26 |
| Last Update Date | 2017-12-26 |