| NPI | 1912079930 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GARY PAUL WELLER CEO And Owner 704-864-6721 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC NC4417) |
| Enumeration Date | 2006-11-14 |
| Last Update Date | 2020-08-22 |