1801115266 NPI number — DRS DEST GARDEN HENDRICK & KINGSBURY PLLC III

Table of content: (NPI 1801115266)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801115266 NPI number — DRS DEST GARDEN HENDRICK & KINGSBURY PLLC III

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DRS DEST GARDEN HENDRICK & KINGSBURY PLLC III
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
DEST FAMILY DENTISTRY OF SPINDALE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1801115266
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/25/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8305 UNIVERSITY EXEC PARK DR STE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28262-3357
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-547-1279
Provider Business Mailing Address Fax Number:
704-547-8383

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1639 US HIGHWAY 74A BYP
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPINDALE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28160-1886
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-547-1279
Provider Business Practice Location Address Fax Number:
704-547-8383
Provider Enumeration Date:
05/25/2010

Additional Information

Authorized Official

Authorized Official Last Name:
DEST
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
F
Authorized Official Title or Position:
MEMBER/MANAGER
Authorized Official Telephone Number:
704-547-1279

Provider Taxonomy Codes

  • Taxonomy code: 122300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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