| NPI | 1508997883 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TODD GENE OWSLEY President 336-288-0677 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NC 34801) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: NC 34801) |
| Enumeration Date | 2007-03-08 |
| Last Update Date | 2010-01-26 |