| NPI | 1982886727 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES WHITE Chief Executive Officer 251-432-4117 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 1223D0001X Dentist, Dental Public Health |
| 1223E0200X Dentist, Endodontics | |
| 1223G0001X Dentist, General Practice | |
| 1223P0221X Dentist, Pediatric Dentistry | |
| 124Q00000X Dental Hygienist | |
| 126800000X Dental Assistant | |
| 126900000X Dental Laboratory Technician | |
| Enumeration Date | 2007-12-04 |
| Last Update Date | 2022-08-30 |