| NPI | 1861605172 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY GALLISDORFER Dentist Partner 336-768-7495 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: NC 5143) |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2020-08-22 |