1306401948 NPI number — CAROLINAS CENTER FOR DENTAL IMPLANTS

Table of content: (NPI 1306401948)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306401948 NPI number — CAROLINAS CENTER FOR DENTAL IMPLANTS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAROLINAS CENTER FOR DENTAL IMPLANTS
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:
Provider Other Organization Name Type Code:
6
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:
1306401948
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/06/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5550 77 CENTER DR STE 320
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:
28217-0739
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-295-4653
Provider Business Mailing Address Fax Number:
704-295-4288

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
280 ROCKY SLOPE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENVILLE
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29607-3908
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-252-9464
Provider Business Practice Location Address Fax Number:
864-482-7510
Provider Enumeration Date:
05/09/2019

Additional Information

Authorized Official

Authorized Official Last Name:
HOCK
Authorized Official First Name:
JENNIFER
Authorized Official Middle Name:
RAYLE
Authorized Official Title or Position:
DIRECTOR OF CONTRACTING AND CREDENT
Authorized Official Telephone Number:
704-295-4653

Provider Taxonomy Codes

  • Taxonomy code: 1223P0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1223S0112X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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