| NPI | 1821390105 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY MITCHELL Owner 336-855-8900 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2010-11-19 |
| Last Update Date | 2010-11-19 |