| NPI | 1497415491 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LEIGHTON M KENNEDY Owner 336-601-6731 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2021-12-19 |
| Last Update Date | 2022-01-05 |