| NPI | 1962569137 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACK L WILHELM Dentist 910-392-1905 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NC 4968) |
| Additional Taxonomies | 122300000X Dentist (Licence: NC 6167) |
| Enumeration Date | 2007-01-03 |
| Last Update Date | 2008-07-02 |