| NPI | 1285228908 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRANDON DALE KOFFORD Officer 919-858-8193 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics |
| Enumeration Date | 2021-02-23 |
| Last Update Date | 2021-02-23 |