| NPI | 1659602498 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIEL D PHELPS Vice President 910-762-3481 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: NC 6077) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: NC 6078) |
| Enumeration Date | 2010-01-19 |
| Last Update Date | 2010-01-19 |