| NPI | 1811915796 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK A TRIPP Owner 704-347-2557 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 7034) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: ND 8356) |
| 1223G0001X Dentist, General Practice (Licence: NC 8861) | |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2012-01-12 |