| Samuel G. Koonce, Jr., Dds, Pa | |
|
900 Spivey Rd Whiteville NC 28472-2915 | |
| (910) 642-4529 | |
| Not Available |
| Full Name | Samuel G. Koonce, Jr., Dds, Pa |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 900 Spivey Rd, Whiteville, North Carolina |
| Authorized Official Name and Position | Samuel Grady Koonce (PRESIDENT) |
| Authorized Official Contact | 9106424529 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Samuel G. Koonce, Jr., Dds, Pa 900 Spivey Rd Po Box 965 Whiteville NC 28472-2915 Ph: (910) 642-4529 | Samuel G. Koonce, Jr., Dds, Pa 900 Spivey Rd Whiteville NC 28472-2915 Ph: (910) 642-4529 |
| NPI Number | 1689842163 |
|---|---|
| Provider Enumeration Date | 02/18/2008 |
| Last Update Date | 02/18/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689842163 | NPI | - | NPPES |
| 8995053 | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 4365 (North Carolina) | Primary |
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