| NPI | 1871558726 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JONN DAVID CIVILS President 336-272-4177 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: 7418) |
| Additional Taxonomies | 122300000X Dentist (Licence: 7263) |
| Enumeration Date | 2006-04-20 |
| Last Update Date | 2020-08-22 |