| NPI | 1992976559 |
|---|---|
| Doing Business As | SOUTHPARK DENTISTRY |
| Entity Type | Organization |
| Authorized Contact | DOUGLAS STUCKEY General Partner 704-364-9686 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: NC NC5980) |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental (Licence: NC NC 7310) |
| Enumeration Date | 2008-03-21 |
| Last Update Date | 2008-03-21 |