| NPI | 1619638970 |
|---|---|
| Doing Business As | HOMELAND AVENUE DENTISTRY |
| Entity Type | Organization |
| Authorized Contact | CHRISTOPHER CLARK President/Dentist 336-272-0132 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Enumeration Date | 2022-01-07 |
| Last Update Date | 2022-01-07 |