| NPI | 1194240671 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALICIA M DUFFY Credentialing Manager 919-295-2757 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery |
| Additional Taxonomies | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2017-08-07 |
| Last Update Date | 2022-05-04 |