| NPI | 1891171138 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RENEE A WALL Owner/Dentist 919-362-1394 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 6732) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NC 9328) |
| Enumeration Date | 2015-08-10 |
| Last Update Date | 2015-08-10 |