Organization
EYES WYDE SHUT INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KINENA DENT-SMITH (FOUNDER)
(980) 777-0801
Entity
Organization
Contact information
Practice address
1209B S YORK ST, GASTONIA, NC 28052-6127
(980) 777-0801
Mailing address
1964 SLIPPERY ROCK LN, MONROE, NC 28112-0005
(980) 777-0801
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
05/15/2023
Last updated
05/15/2023
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