| NPI | 1356730741 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LUCENDA HARRIS Credentialing & Contracting COO Rdin 980-729-5200 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: NC 9277) |
| Enumeration Date | 2015-01-22 |
| Last Update Date | 2021-07-09 |