| NPI | 1790660603 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SONYA MYRICK Director Of Credentialing & Payer R 980-390-2807 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry |
| Enumeration Date | 2025-08-08 |
| Last Update Date | 2025-08-08 |