Medical school: OHIO STATE UNIVERSITY COLLEGE OF DENTISTRY
Graduated: 2003
NPI: 1063725679
Practice Locations (2)
300 E WENDOVER AVE, ATTN PAYOR ENROLLMENT 2ND FLOOR
Greensboro, NC 274011221
300 E WENDOVER AVE, ATTN PAYOR ENROLLMENT 2ND FLOOR
GREENSBORO, NC 274011221
Source: CMS National Downloadable File, September 2026.