| NPI | 1447964754 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAREE JOHNSON Owner 919-526-1000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry |
| Enumeration Date | 2023-01-11 |
| Last Update Date | 2023-01-17 |