| NPI | 1528729555 |
|---|---|
| Doing Business As | SOUTHERN PINES DENTAL |
| Entity Type | Organization |
| Authorized Contact | KYLE GRESHAM Member 318-855-1426 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2022-01-03 |
| Last Update Date | 2022-01-03 |