| NPI | 1417179581 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EDWARD PATTON JESSUP Owner 910-738-4465 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NC 3568) |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2020-08-22 |