| NPI | 1710477153 |
|---|---|
| Doing Business As | MYRTLE GROVE IMPLANT AND FAMILY DENTISTRY |
| Entity Type | Organization |
| Authorized Contact | NATHAN GRAVES Owner 910-742-0664 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: NC 10216) |
| Enumeration Date | 2018-05-11 |
| Last Update Date | 2018-05-11 |