| NPI | 1285703876 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELISSA MARKS GUSTAFSON Owner 704-596-0021 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 7153) |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2017-01-18 |