| NPI | 1194838755 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRENT LASHLEY BLAYLOCK Owner President 919-493-8036 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 4970) |
| Enumeration Date | 2006-08-17 |
| Last Update Date | 2008-07-07 |