| 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 |