| NPI | 1205125226 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTIE VAUGHN Staff 251-344-4994 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: AL 3001) |
| Additional Taxonomies | 122300000X Dentist (Licence: AL 5206) |
| 122300000X Dentist (Licence: AL 5486) | |
| Enumeration Date | 2011-03-30 |
| Last Update Date | 2011-03-30 |