| NPI | 1457637621 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DENISE CLARK Office Manager 704-869-9661 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery | |
| Enumeration Date | 2011-11-01 |
| Last Update Date | 2011-11-01 |