Organization
OBI-GWACHAM ROUPAS SULLIVAN TREMONT PLLC-1
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TAYLOR PLYLER (MANAGER)
(843) 517-9960
Entity
Organization
Contact information
Practice address
560 WOODHAVEN PL NW, CONCORD, NC 28027-5710
(704) 343-5574
Mailing address
5833 PHYLISS LN, MINT HILL, NC 28227-9031
(843) 517-9960
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
11/07/2024
Last updated
11/07/2024
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