| NPI | 1790502946 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSICA HUNTER Director Of Network Relations 704-780-4597 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice |
| Enumeration Date | 2024-09-20 |
| Last Update Date | 2025-10-27 |