| NPI | 1457936163 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIFFANY LORICK Credentialing Specialist 919-948-6787 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2021-03-15 |
| Last Update Date | 2021-04-10 |