| NPI | 1891594032 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAURA ILLINGWORTH Rcm 919-266-5332 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2025-03-11 |
| Last Update Date | 2025-04-16 |