| NPI | 1417179904 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANDREW DEXTER DUNAVANT Owner 251-974-1512 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: AL 4155) |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2020-08-22 |