| NPI | 1518351170 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELISSA GILLILAND UNDERWOOD Office Manager 251-653-1300 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2015-03-22 |
| Last Update Date | 2019-05-29 |