| NPI | 1568161263 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMY BROOKS Credentialing Manager 252-292-1349 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics |
| 1223E0200X Dentist, Endodontics | |
| Enumeration Date | 2023-03-01 |
| Last Update Date | 2023-11-28 |