| NPI | 1952940926 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALICIA DUFFY Credentialing Manager 919-295-2757 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 122300000X Dentist |
| Enumeration Date | 2019-12-23 |
| Last Update Date | 2022-10-21 |