MEDICARE: DRS DEST GARDEN HENDRICK & KINGSBURY PLLC II

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	1223G0001X	General Practice Dentistry	5283	NC

General Provider Information

NPI Number	:	1689997942
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DRS DEST GARDEN HENDRICK & KINGSBURY PLLC II

Provider Business Mailing Address
First Line	:	8305 UNIVERSITY EXEC PARK DR
Second Line	:	SUITE 300
City	:	CHARLOTTE
State	:	NC
Zip	:	28262-1361
Country	:	US
Telephone Number	:	704-547-1279
Fax Number	:	704-547-8383

Provider Business Practice Location Address
First Line	:	231 N 1ST ST
Second Line	:
City	:	ALBEMARLE
State	:	NC
Zip	:	28001-3902
Country	:	US
Telephone Number	:	704-982-2216
Fax Number	:	704-983-9957

Authorized Official
Title or Position	:	MEMBER/PARTNER
Name	:	DR. RICHARD F DEST
Credential	:	DDS
Telephone Number	:	704-737-3133

Provider Enumeration Date	:	03/01/2010
Last Update Date	:	03/01/2010

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