| NPI | 1811695554 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LUCENDA HARRIS Credentialing And Contracting Coord 704-361-9508 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry |
| Enumeration Date | 2023-02-22 |
| Last Update Date | 2023-02-22 |