| NPI | 1811433550 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PHILIP FREDERIC JIAMACHELLO Pediatric Dentist 704-484-3366 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry |
| Additional Taxonomies | 122300000X Dentist |
| Enumeration Date | 2017-01-18 |
| Last Update Date | 2017-01-18 |