Individual
BIN NA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
9648 CHAPEL HILL RD # SET100, MORRISVILLE, NC 27560-7844
(919) 322-3588
Mailing address
750 MCRAE RD, CARY, NC 27519-0116
(949) 383-0787
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
10828
NC
Other
Enumeration date
01/10/2018
Last updated
01/10/2018
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