| NPI | 1770033086 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEISHA BROOKE TAMAR-LOCKWOOD Office Manager 919-806-8060 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NC 7271) |
| Additional Taxonomies | 122300000X Dentist (Licence: NC 8867) |
| Enumeration Date | 2016-10-11 |
| Last Update Date | 2016-10-11 |