| NPI | 1811412562 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KAROL MANCHOLA Office Manager 980-875-9158 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NC 9178) |
| Additional Taxonomies | 122300000X Dentist (Licence: NC 9054) |
| Enumeration Date | 2017-08-03 |
| Last Update Date | 2021-05-06 |