Facts
- Status
- A
- Credential
- D.D.S.
- Type
- Individual
- Enumeration date
- 2006-06-26
- Last updated
- 2007-07-08
Specialties
Licenses
- License NC
- 3898
Location
- Practice location
- 49 ANDERSON ST
- City
- DENTON NC
- Postal code
- 27239
- Phone
- 336-859-4581
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
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Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.