| NPI | 1942420179 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LACEY EARL GANE Owner 910-738-2473 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NC 4712) |
| Additional Taxonomies | 122300000X Dentist (Licence: NC 6995) |
| Enumeration Date | 2007-04-30 |
| Last Update Date | 2012-10-02 |