| NPI | 1750553517 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RONALD D. GAITROS Officer/Director 910-762-2618 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: ND 5707) |
| Enumeration Date | 2008-04-01 |
| Last Update Date | 2009-04-24 |