Creedmoor Family Dentistry | |
110 W Church St Creedmoor NC 27522-9747 | |
(919) 528-4004 | |
(919) 528-2211 |
Full Name | Creedmoor Family Dentistry |
---|---|
Speciality | Dentist |
Location | 110 W Church St, Creedmoor, North Carolina |
Authorized Official Name and Position | Benjamin Victor Koren (OWNER) |
Authorized Official Contact | 9195284004 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Creedmoor Family Dentistry 110 W Church St Creedmoor NC 27522-9747 Ph: (919) 528-4004 | Creedmoor Family Dentistry 110 W Church St Creedmoor NC 27522-9747 Ph: (919) 528-4004 |
NPI Number | 1336170042 |
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Provider Enumeration Date | 07/05/2006 |
Last Update Date | 08/22/2020 |
Identifier | Type | State | Issuer |
---|---|---|---|
1336170042 | NPI | - | NPPES |
5902042 | Medicaid | NC | |
017JW | Other | NC | BCBS GROUP NUMBER |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
122300000X | Dentist | 6997 (North Carolina) | Primary |
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