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2824 Rogers Rd Suite 200 Wake Forest NC 27587 | |
(919) 923-8513 | |
Not Available |
Full Name | |
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Speciality | Dentist - Orthodontics And Dentofacial Orthopedics |
Location | 2824 Rogers Rd, Wake Forest, North Carolina |
Authorized Official Name and Position | Jason Thomas Gladwell (CEO/ ORTHODONTIST) |
Authorized Official Contact | 9199238513 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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3650 Rogers Rd #330 Wake Forest NC 27587-9306 Ph: (919) 923-8513 | 2824 Rogers Rd Suite 200 Wake Forest NC 27587 Ph: (919) 923-8513 |
NPI Number | 1467642082 |
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Provider Enumeration Date | 07/30/2007 |
Last Update Date | 07/30/2007 |
Identifier | Type | State | Issuer |
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1467642082 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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1223X0400X | Dentist - Orthodontics And Dentofacial Orthopedics | 7981 (North Carolina) | Primary |