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1001 Stadium Dr Ste 120 Wake Forest NC 27587-3308 | |
(919) 570-9100 | |
Not Available |
Full Name | |
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Speciality | Dentist - General Practice |
Location | 1001 Stadium Dr Ste 120, Wake Forest, North Carolina |
Authorized Official Name and Position | Hillary Thull (CREDENTIALING COORDINATOR) |
Authorized Official Contact | 2175408946 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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1001 Stadium Dr Ste 120 Wake Forest NC 27587-3308 Ph: () - | 1001 Stadium Dr Ste 120 Wake Forest NC 27587-3308 Ph: (919) 570-9100 |
NPI Number | 1598424533 |
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Provider Enumeration Date | 12/16/2021 |
Last Update Date | 10/04/2024 |
Identifier | Type | State | Issuer |
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1598424533 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |