| Fairmont Dental Inc | |
|
304 Iona St Fairmont NC 28340-1618 | |
| (910) 628-7166 | |
| (910) 628-7167 |
| Full Name | Fairmont Dental Inc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 304 Iona St, Fairmont, North Carolina |
| Authorized Official Name and Position | Samuel G Evans (PRESIDENT CEO) |
| Authorized Official Contact | 9106287166 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Fairmont Dental Inc 304 Iona St Fairmont NC 28340-1618 Ph: (910) 628-7166 | Fairmont Dental Inc 304 Iona St Fairmont NC 28340-1618 Ph: (910) 628-7166 |
| NPI Number | 1598800039 |
|---|---|
| Provider Enumeration Date | 02/21/2007 |
| Last Update Date | 01/17/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598800039 | NPI | - | NPPES |
| 92534 | Other | BLUE CROSS BLUE SHIELD | |
| 8992534 | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 5286 (North Carolina) | Primary |
Partners Dental Extraction Center Of Fairmont Pllc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 304 Iona St, Fairmont, NC 28340 Phone: 910-628-7166 Fax: 910-535-4306 |