| NPI | 1689842163 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SAMUEL GRADY KOONCE President 910-642-4529 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental (Licence: NC 4365) |
| Enumeration Date | 2008-02-18 |
| Last Update Date | 2008-02-18 |