| NPI | 1811576515 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHALA DAVIS Rcs Manager 704-303-7517 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery |
| Enumeration Date | 2021-04-08 |
| Last Update Date | 2021-09-02 |