| NPI | 1992909600 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RENEE ALLEN DYKEN President 251-968-1310 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: AL 4630) |
| Enumeration Date | 2007-06-14 |
| Last Update Date | 2020-08-22 |