| NPI | 1538935432 |
|---|---|
| Doing Business As | SOUTHLAKE PEDIATRIC DENTISTRY |
| Entity Type | Organization |
| Authorized Contact | CHAD HENDRICKS Credentialing 704-997-6431 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry |
| Additional Taxonomies | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2023-11-30 |
| Last Update Date | 2023-12-19 |