| NPI | 1326443870 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REBECCA M BROWN Credentialing 910-267-8252 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental |
| Additional Taxonomies | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2014-10-27 |
| Last Update Date | 2020-09-25 |