| NPI | 1790039212 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ZACHARY TODD DAUGHERTY Business Manager 910-526-3487 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: SC SC2662) |
| Enumeration Date | 2012-11-06 |
| Last Update Date | 2012-11-06 |