| NPI | 1306482104 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEITH RICHARD REUBEN GAUGHT President 919-847-6453 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2019-11-27 |
| Last Update Date | 2021-08-20 |