| NPI | 1972654655 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMMY MORAN Comptroller 910-814-2944 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 4785) |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2020-08-22 |