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Dental Providers Dentist

Provider NPI: 1447468822

Provider Information:
Gender: M
Not Sole Proprietor

Practice Location:
Tel: 919-469-2122  Fax: 919-469-2204

Business Mailing Address:
Tel: 919-977-0627  Fax: 919-977-4079

NPI Information:
NPI: 1447468822
Entity Type: Individual


PrimaryCodeCategory/DescriptionStateLicense Number
N122300000XDental Providers
Y1223G0001XDental Providers

Other Provider Identifiers:


American Medical Association 2012 taxonomy code information

Code: 1223G0001X





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