| NPI | 1619543030 |
|---|---|
| Doing Business As | CAROLINASDENTIST |
| Entity Type | Organization |
| Authorized Contact | CHAD HENDRICKS Credentialing Manager 612-859-0444 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Enumeration Date | 2021-05-27 |
| Last Update Date | 2021-05-27 |