| NPI | 1962634816 |
|---|---|
| Former Legal Business Name | SOUTH END DENTISTRY |
| Entity Type | Organization |
| Authorized Contact | MICHEAL SCOTT WILSON Dentist/Owner 704-333-4760 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NC 8162) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice |
| 1223G0001X Dentist, General Practice (Licence: NC 8162) | |
| Enumeration Date | 2009-08-11 |
| Last Update Date | 2010-04-02 |