| NPI | 1205040953 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID G POLHEMUS Manager, Member 919-870-7104 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: NC 5779) |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2020-08-22 |