| NPI | 1700491685 |
|---|---|
| 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 |
| Enumeration Date | 2020-09-09 |
| Last Update Date | 2020-09-09 |