| NPI | 1992971915 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILSON O'KELLY JEWELL Member Manager 910-791-2401 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 6483) |
| Enumeration Date | 2008-04-30 |
| Last Update Date | 2008-04-30 |