| NPI | 1609640291 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBIN BASS Administrator 252-752-6188 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2023-11-14 |
| Last Update Date | 2024-04-17 |