| NPI | 1649441098 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALVIN GILDEROY PETTIT Owner 910-686-3619 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: NC 5676) |
| Enumeration Date | 2008-03-13 |
| Last Update Date | 2008-03-13 |