| NPI | 1972554186 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER RAYLE HOCK Director Of Billing 704-295-4653 |
| Organization Subpart ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2023-03-20 |