| NPI | 1477728764 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM S KIRK Owner 704-332-3701 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NC 4501) |
| Additional Taxonomies | 122300000X Dentist (Licence: NC 4501) |
| 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: NC 4501) | |
| 1223X0008X Dentist, Oral and Maxillofacial Radiology (Licence: NC 4501) | |
| Enumeration Date | 2008-04-28 |
| Last Update Date | 2008-05-07 |