| NPI | 1912117615 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIMBERLY S. WILSON Office Assistant 704-892-7866 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 6100) |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2020-08-22 |