| NPI | 1578743597 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JERRY SHUMATE ALVIS Owner/Dentist 919-782-5752 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: NC 6792) |
| Enumeration Date | 2007-11-07 |
| Last Update Date | 2007-11-07 |