| NPI | 1578720967 |
|---|---|
| Doing Business As | KINGS MOUNTAIN MEDICAID DENTISTRY |
| Entity Type | Organization |
| Authorized Contact | RICHARD F DEST Registered Agent/Member 704-547-1279 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 5283) |
| Enumeration Date | 2008-05-22 |
| Last Update Date | 2008-05-28 |