| NPI | 1225074172 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOEL A BLACK President 336-765-5421 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NC 3648) |
| Enumeration Date | 2006-06-21 |
| Last Update Date | 2020-08-22 |