| NPI | 1659495364 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHAUNCY NELSON Owner 910-845-3900 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NC 5991) |
| Enumeration Date | 2007-03-19 |
| Last Update Date | 2020-08-22 |