| NPI | 1699047167 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRUCE RAY TRIPP Owner 252-752-7880 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NC 5112) |
| Additional Taxonomies | 124Q00000X Dental Hygienist |
| Enumeration Date | 2012-01-31 |
| Last Update Date | 2013-08-09 |