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202 Williamson Rd Suite 200 Mooresville NC 28117-7610 | |
| (704) 360-8670 | |
| (704) 360-8675 |
| Full Name | |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 202 Williamson Rd, Mooresville, North Carolina |
| Authorized Official Name and Position | Lucenda Harris (CREDENTIALING & CONTRACTING COORDIN) |
| Authorized Official Contact | 9807295200 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 746220 Atlanta GA 30374-6220 Ph: (704) 360-8670 | 202 Williamson Rd Suite 200 Mooresville NC 28117-7610 Ph: (704) 360-8670 |
| NPI Number | 1124457817 |
|---|---|
| Provider Enumeration Date | 11/04/2013 |
| Last Update Date | 06/16/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124457817 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | (North Carolina) | Primary |
Rivera & Associates, P.a. Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 400 E Statesville Ave, Mooresville, NC 28115 Phone: 704-816-1401 | |
Drs Groody And Reimels Pllc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 136 Rocky River Rd, Mooresville, NC 28115 Phone: 704-782-2630 | |
K. Jasinski, D.m.d., P.c. Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 128 Kistler Farm Rd Ste 5, Mooresville, NC 28115 Phone: 980-528-4180 Fax: 980-528-4178 |