| NPI | 1528277217 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK MARIAN PETRYNA Oral Surgeon 704-847-7799 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NC 6075) |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2020-08-22 |