| NPI | 1790981330 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN WALTON BLACKMAN Owner Dentist 336-760-9258 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 3165) |
| Enumeration Date | 2007-06-21 |
| Last Update Date | 2020-08-22 |