| NPI | 1548676919 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOEL M WAGONER Owner 919-968-9697 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 4126) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NC 8321) |
| Enumeration Date | 2014-07-07 |
| Last Update Date | 2014-07-07 |