| |
1900 S Main St Ste 206 Wake Forest NC 27587-5026 | |
(919) 562-7008 | |
(919) 562-9809 |
Full Name | |
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Speciality | Dentist - General Practice |
Location | 1900 S Main St, Wake Forest, North Carolina |
Authorized Official Name and Position | Michael Steven Watson (PRES.) |
Authorized Official Contact | 9195627008 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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1900 S Main St # 206 Wake Forest NC 27587-5026 Ph: (919) 562-7008 | 1900 S Main St Ste 206 Wake Forest NC 27587-5026 Ph: (919) 562-7008 |
NPI Number | 1942509534 |
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Provider Enumeration Date | 03/22/2011 |
Last Update Date | 05/16/2013 |
Identifier | Type | State | Issuer |
---|---|---|---|
1942509534 | NPI | - | NPPES |
5917582 | Medicaid | NC |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
1223G0001X | Dentist - General Practice | 6282 (North Carolina) | Primary |