| NPI | 1386015741 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LTANYA JOY BAILEY Owner 336-886-7000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2015-10-12 |
| Last Update Date | 2015-10-13 |