NPI | 1578114732 |
---|---|
Entity Type | Organization |
Authorized Contact | ALICIA DUFFY Credentialing Manager 919-295-2757 |
Organization Subpart ? | No |
Primary Taxonomy | 122300000X Dentist |
Additional Taxonomies | 1223G0001X Dentist, General Practice |
Enumeration Date | 2019-09-27 |
Last Update Date | 2022-04-28 |