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1936 Heritage Branch Rd Ste 200 Wake Forest NC 27587-7062 | |
(919) 554-9955 | |
Not Available |
Full Name | |
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Speciality | Dentist - General Practice |
Location | 1936 Heritage Branch Rd Ste 200, Wake Forest, North Carolina |
Authorized Official Name and Position | Amena Holley (CREDENTIALING SPECIALIST) |
Authorized Official Contact | 2485505440 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 603766 Charlotte NC 28260-3766 Ph: () - | 1936 Heritage Branch Rd Ste 200 Wake Forest NC 27587-7062 Ph: (919) 554-9955 |
NPI Number | 1598470635 |
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Provider Enumeration Date | 01/23/2023 |
Last Update Date | 01/25/2023 |
Identifier | Type | State | Issuer |
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1598470635 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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122300000X | Dentist | (* (Not Available)) | Secondary |
1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |