| NPI | 1588347918 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEIGH SLACK DEATON Financial COO Rdinator 336-274-7649 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2023-08-11 |
| Last Update Date | 2023-08-11 |