| NPI | 1508082421 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | M BRAD FORREST President 704-882-1113 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: NC NC6763) |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2008-07-28 |