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3205 Rogers Rd Wake Forest NC 27587-3805 | |
(909) 453-2300 | |
(919) 453-2301 |
Full Name | |
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Speciality | Dentist |
Location | 3205 Rogers Rd, Wake Forest, North Carolina |
Authorized Official Name and Position | Kim R Melton (PRESIDENT) |
Authorized Official Contact | 9194532300 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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3205 Rogers Rd Wake Forest NC 27587-3805 Ph: (909) 453-2300 | 3205 Rogers Rd Wake Forest NC 27587-3805 Ph: (909) 453-2300 |
NPI Number | 1679788202 |
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Provider Enumeration Date | 05/14/2007 |
Last Update Date | 08/22/2020 |
Identifier | Type | State | Issuer |
---|---|---|---|
1679788202 | NPI | - | NPPES |
8990174 | Medicaid | NC |
Taxonomy | Type | License (State) | Status |
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122300000X | Dentist | 7307 (North Carolina) | Primary |