| NPI | 1962948133 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EDWARD RILEY Chief Executive Office 704-637-6717 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental (Licence: NC 5500) |
| Enumeration Date | 2017-01-12 |
| Last Update Date | 2017-01-12 |