| NPI | 1356688857 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KERVIN MACK Owner 336-227-5594 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NC 8824) |
| Enumeration Date | 2013-01-03 |
| Last Update Date | 2013-01-03 |