| NPI | 1861333734 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SONYA MYRICK Director Of Payor Relations & Cred 980-390-2807 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry |
| Enumeration Date | 2026-04-03 |
| Last Update Date | 2026-04-03 |