| NPI | 1568531861 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK WINTON JOHNSON Vice President 252-638-6177 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NC 1223S0112X) |
| Enumeration Date | 2006-11-08 |
| Last Update Date | 2020-09-09 |