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304 Capcom Ave Wake Forest NC 27587-6598 | |
(919) 556-3130 | |
(919) 556-6180 |
Full Name | |
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Speciality | Dentist - General Practice |
Location | 304 Capcom Ave, Wake Forest, North Carolina |
Authorized Official Name and Position | Tran M Nguyen (PRESIDENT) |
Authorized Official Contact | 9195563130 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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123 Capcom Ave Ste 5 Wake Forest NC 27587-6517 Ph: (919) 556-3130 | 304 Capcom Ave Wake Forest NC 27587-6598 Ph: (919) 556-3130 |
NPI Number | 1720443542 |
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Provider Enumeration Date | 12/21/2015 |
Last Update Date | 12/21/2015 |
Identifier | Type | State | Issuer |
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1720443542 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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1223G0001X | Dentist - General Practice | 7074 (North Carolina) | Primary |