Individual
OMRI EMODI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D
Contact information
Practice address
101 MANNING DR, CHAPEL HILL, NC 27514-4220
(919) 843-4810
Mailing address
143 W FRANKLIN ST, CHAPEL HILL, NC 27516-2539
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
0109
NC
Other
Enumeration date
08/04/2011
Last updated
08/04/2011
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