| NPI | 1821313446 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RANDALL LEE MCCLARY Dentist/Owner 336-294-5020 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: NC 8135) |
| Additional Taxonomies | 1223G0001X Dentist General Practice |
| 122300000X Dentist (Licence: NC 6541) | |
| 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics | |
| 122300000X Dentist | |
| 1223P0700X Dentist Prosthodontics | |
| 1223E0200X Dentist Endodontics | |
| 1223P0300X Dentist Periodontics | |
| 1223P0221X Dentist Pediatric Dentistry | |
| Enumeration Date | 2010-04-07 |
| Last Update Date | 2014-07-01 |