| NPI | 1427226984 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | J. RANDALL LATTA President 252-305-1286 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 4081) |
| Enumeration Date | 2008-02-18 |
| Last Update Date | 2008-02-18 |