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5511 Raeford Rd Ste 225 Fayetteville NC 28304-2060 | |
(910) 485-0023 | |
Not Available |
Full Name | |
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Speciality | Dentist |
Location | 5511 Raeford Rd Ste 225, Fayetteville, North Carolina |
Authorized Official Name and Position | Tan Binh Phan Nguyen (OWNER/ MANAGER) |
Authorized Official Contact | 6787612457 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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2413 Thorngrove Ct Fayetteville NC 28303-4099 Ph: (910) 263-8034 | 5511 Raeford Rd Ste 225 Fayetteville NC 28304-2060 Ph: (910) 485-0023 |
NPI Number | 1174916902 |
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Provider Enumeration Date | 03/18/2015 |
Last Update Date | 03/18/2015 |
Identifier | Type | State | Issuer |
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1174916902 | NPI | - | NPPES |
5918338 | Medicaid | NC |
Taxonomy | Type | License (State) | Status |
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122300000X | Dentist | 9227 (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 | |