MEDICARE: FELIPE JUNGBLUT MOHR DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	1223G0001X	General Practice Dentistry	12892	NC

General Provider Information

NPI Number	:	1437898046
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FELIPE JUNGBLUT MOHR DDS

Provider Business Mailing Address
First Line	:	1105 BARLEY STONE WAY
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27603-5194
Country	:	US
Telephone Number	:	636-448-4658
Fax Number	:

Provider Business Practice Location Address
First Line	:	2050 SKIBO RD STE 104
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28314-3161
Country	:	US
Telephone Number	:	910-605-4106
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2022
Last Update Date	:	07/13/2022

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