1720124373 NPI number — DR. CHRISTOPHER ASHLEY FAUCETTE DDS PA

Table of content: DR. CHRISTOPHER ASHLEY FAUCETTE DDS PA (NPI 1720124373)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720124373 NPI number — DR. CHRISTOPHER ASHLEY FAUCETTE DDS PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FAUCETTE
Provider First Name:
CHRISTOPHER
Provider Middle Name:
ASHLEY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS PA
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1720124373
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6303 CARMEL ROAD S
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28226
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-542-7555
Provider Business Mailing Address Fax Number:
704-542-5147

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6303 CARMEL RD
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28226
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-542-7555
Provider Business Practice Location Address Fax Number:
704-542-5147
Provider Enumeration Date:
01/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  6336 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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