| NPI | 1730474131 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHELLEY OLSON Dentist 919-693-4090 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NC 7405) |
| Additional Taxonomies | 122300000X Dentist (Licence: NC 3845) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: NC 7017) | |
| Enumeration Date | 2011-06-14 |
| Last Update Date | 2011-06-14 |