| NPI | 1659151116 |
|---|---|
| Doing Business As | COMMONWEALTH SPECIALTY - FOREST HILL |
| Entity Type | Organization |
| Authorized Contact | MICHAEL RICCOBENE CEO 910-853-6172 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics |
| 1223P0221X Dentist, Pediatric Dentistry | |
| Enumeration Date | 2023-10-03 |
| Last Update Date | 2024-08-02 |