| NPI | 1720553191 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACY DAVIDIAN Owner 919-301-8133 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies Customized Equipment |
| Additional Taxonomies | 122300000X Dentist |
| Enumeration Date | 2018-10-11 |
| Last Update Date | 2018-10-11 |