| NPI | 1780868174 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARLA LYNN WATTS Office Manager 704-895-3775 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 6757) |
| Enumeration Date | 2007-12-21 |
| Last Update Date | 2007-12-21 |