| NPI | 1700650371 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JALONDA SWEENEY Credentialing Specialist 704-997-8878 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry |
| Additional Taxonomies | 1223G0001X Dentist General Practice |
| Enumeration Date | 2023-11-14 |
| Last Update Date | 2023-11-14 |