| NPI | 1497035273 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES DAVID STODDARD Owner 251-948-9313 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AL 3129) |
| Enumeration Date | 2011-08-24 |
| Last Update Date | 2011-08-24 |