| NPI | 1649963042 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRADLY KALB RUSSELL Oral Surgeon 336-765-9550 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Enumeration Date | 2023-05-31 |
| Last Update Date | 2023-05-31 |