| NPI | 1497465207 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALICIA M DUFFY Credentialing Manager 919-295-2757 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2022-12-02 |
| Last Update Date | 2023-02-15 |