| |
1357 Walter Reed Rd Suite 101 Fayetteville NC 28304-4415 | |
(910) 483-2700 | |
(910) 484-3352 |
Full Name | |
---|---|
Speciality | Dentist - General Practice |
Location | 1357 Walter Reed Rd, Fayetteville, North Carolina |
Authorized Official Name and Position | Shelley Howe (INSURANCE SUPERVISOR) |
Authorized Official Contact | 9104832700 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
1357 Walter Reed Rd Suite 101 Fayetteville NC 28304-4415 Ph: (910) 483-2700 | 1357 Walter Reed Rd Suite 101 Fayetteville NC 28304-4415 Ph: (910) 483-2700 |
NPI Number | 1396804308 |
---|---|
Provider Enumeration Date | 12/06/2006 |
Last Update Date | 08/22/2020 |
Identifier | Type | State | Issuer |
---|---|---|---|
1396804308 | NPI | - | NPPES |
5902187 | Medicaid | NC |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
1223G0001X | Dentist - General Practice | 8077 (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 | |