| NPI | 1346479987 |
|---|---|
| Doing Business As | SOUTHPARK PEDIATRIC DENTISTRY |
| Entity Type | Organization |
| Authorized Contact | ANDREW M JOHNSON President/Owner 704-749-5700 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NC 8388) |
| Enumeration Date | 2009-07-03 |
| Last Update Date | 2009-07-03 |