| NPI | 1790812063 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PHYLLIS COOK President Owner 910-256-8486 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: NC 6551) |
| Enumeration Date | 2007-02-27 |
| Last Update Date | 2008-02-28 |