| NPI | 1578782116 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANNON REAVIS Office Manager 336-765-7477 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 5856) |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2020-08-22 |