| NPI | 1205868080 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BETHANY H. FORTNER Office Manager 704-636-1848 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 5908) |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2009-02-09 |