| NPI | 1811192552 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EDWARD ERNEST DICKERSON Owner 910-323-3757 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2082S0099X Plastic Surgery, Plastic Surgery Within the Head and Neck |
| Additional Taxonomies | 261Q00000X |
| Enumeration Date | 2007-06-20 |
| Last Update Date | 2021-07-14 |