| NPI | 1770784183 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANA SEVERT BODDORF Practice Manager 919-859-6633 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 4916) |
| Enumeration Date | 2007-05-31 |
| Last Update Date | 2020-08-22 |