| NPI | 1326659897 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICHARD B VELAZQUE Director Of Implementation 704-218-2132 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice |
| Enumeration Date | 2020-08-10 |
| Last Update Date | 2020-08-10 |