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Dentists, Dental Clinics and Practices
Oral Surgery, Dental Specialists

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Shelby, North Carolina

Provider NPI: 1245313600

Provider Information:
Gender: M
Sole Proprietor

Practice Location:
Tel: 704-484-0148  Fax: 704-484-0148

Business Mailing Address:
Tel: 704-484-0148  Fax: 704-484-0148

Entity Type: Individual


PrimaryCodeCategory/DescriptionStateLicense Number
Y1223P0300XDental Providers

Other Provider Identifiers:

Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin


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