| NPI | 1730235888 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAN CHARLES KRASKA Owner 336-292-0863 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: NC 4505) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: NC 8000) |
| Enumeration Date | 2007-01-25 |
| Last Update Date | 2007-11-15 |