| NPI | 1801067327 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRANDI MYRICK PARKER Account Coordinator 704-377-3694 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry |
| Additional Taxonomies | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2008-03-13 |
| Last Update Date | 2008-03-13 |