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2901 Breezewood Ave Suite 101 Fayetteville NC 28303-5409 | |
(443) 762-1987 | |
Not Available |
Full Name | |
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Speciality | Clinic/center - Dental |
Location | 2901 Breezewood Ave, Fayetteville, North Carolina |
Authorized Official Name and Position | Kingsley Oise Momodu (DENTAL SURGEON/PROPRIETOR) |
Authorized Official Contact | 4437621987 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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2901 Breezewood Ave Suite 101 Fayetteville NC 28303-5409 Ph: (443) 762-1987 | 2901 Breezewood Ave Suite 101 Fayetteville NC 28303-5409 Ph: (443) 762-1987 |
NPI Number | 1801148457 |
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Provider Enumeration Date | 10/06/2012 |
Last Update Date | 05/11/2023 |
Identifier | Type | State | Issuer |
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1801148457 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QD0000X | Clinic/center - Dental | #9234 (North Carolina) | Primary |
Knowles, Smith & Associates, Llp Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 2409 Robeson St, Fayetteville, NC 28305 Phone: 910-483-9546 | |