Healthcare Provider Details

I. General information

NPI: 1396725743
Provider Name (Legal Business Name): FIRSTHEALTH DENTAL CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2006
Last Update Date: 12/04/2024
Certification Date: 12/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

195 CAMELOT COURT
BISCOE NC
27209
US

IV. Provider business mailing address

195 CAMELOT COURT
BISCOE NC
27209
US

V. Phone/Fax

Practice location:
  • Phone: 910-572-1700
  • Fax: 910-572-1720
Mailing address:
  • Phone: 910-572-1700
  • Fax: 910-572-1720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License NumberH0100
License Number StateNC

VIII. Authorized Official

Name: MICKEY FOSTER
Title or Position: CEO
Credential:
Phone: 910-715-4473