| NPI | 1467193599 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW JEFFREY JOHNSON Physician 704-360-9995 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery |
| Enumeration Date | 2022-04-05 |
| Last Update Date | 2022-05-03 |