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136 Indian Trail Rd S Indian Trail NC 28079-9669 | |
| (704) 821-7222 | |
| (704) 821-4310 |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 136 Indian Trail Rd S, Indian Trail, North Carolina |
| Authorized Official Name and Position | Richard Mark Holmes (OWNER) |
| Authorized Official Contact | 7048217222 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 338 Indian Trail NC 28079-0338 Ph: (704) 821-7222 | 136 Indian Trail Rd S Indian Trail NC 28079-9669 Ph: (704) 821-7222 |
| NPI Number | 1689716599 |
|---|---|
| Provider Enumeration Date | 02/14/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689716599 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | NC6039 (North Carolina) | Primary |
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