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3415 Rogers Rd Suite 100 Wake Forest NC 27587-3809 | |
(919) 554-9955 | |
(919) 554-9955 |
Full Name | |
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Speciality | Dentist - General Practice |
Location | 3415 Rogers Rd, Wake Forest, North Carolina |
Authorized Official Name and Position | Jonathan Boes (OWNER) |
Authorized Official Contact | 9194692122 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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3415 Rogers Rd Suite 100 Wake Forest NC 27587-3809 Ph: (919) 554-9955 | 3415 Rogers Rd Suite 100 Wake Forest NC 27587-3809 Ph: (919) 554-9955 |
NPI Number | 1164732160 |
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Provider Enumeration Date | 10/09/2010 |
Last Update Date | 10/09/2010 |
Identifier | Type | State | Issuer |
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1164732160 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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1223G0001X | Dentist - General Practice | 8432 (North Carolina) | Primary |