| NPI | 1366118036 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TYLER LANCE MATTHEW GOODRIDGE General Dentist/Owner 252-670-0713 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2021-08-21 |
| Last Update Date | 2021-08-23 |