| NPI | 1679203913 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER RAYLE HOCK Director Of Billing 704-295-4653 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery |
| Enumeration Date | 2022-06-10 |
| Last Update Date | 2022-12-01 |