| NPI | 1881975191 |
|---|---|
| Doing Business As | NORTHEAST PEDIATRIC DENTISTRY |
| Entity Type | Organization |
| Authorized Contact | BRANDI R JACKSON Owner/Dentist 704-895-6445 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NC 8224) |
| Enumeration Date | 2011-08-31 |
| Last Update Date | 2011-08-31 |