| NPI | 1902081094 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH RAY RUSSELL President 336-768-7940 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 5843) |
| Enumeration Date | 2008-01-08 |
| Last Update Date | 2008-01-08 |