| NPI | 1497180749 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAURA ILLINGWORTH Rcm 919-266-5332 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223D0001X Dentist, Dental Public Health |
| Additional Taxonomies | 122300000X Dentist |
| Enumeration Date | 2013-09-05 |
| Last Update Date | 2025-02-11 |