| NPI | 1598959538 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANNY KETOLA Business Administrator 704-820-1187 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Enumeration Date | 2007-09-04 |
| Last Update Date | 2007-09-04 |