| NPI | 1568678365 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GLORIA D EDAHL Office Manager 704-365-0888 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: NC 6324) |
| Enumeration Date | 2007-05-16 |
| Last Update Date | 2007-09-11 |