Healthcare Provider Details

I. General information

NPI: 1023432408
Provider Name (Legal Business Name): SURGICAL PARTNERS OF NORTH CAROLINA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2014
Last Update Date: 02/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 NW CARY PKWY SUITE 105
CARY NC
27513-8444
US

IV. Provider business mailing address

3600 NW CARY PKWY SUITE 105
CARY NC
27513-8444
US

V. Phone/Fax

Practice location:
  • Phone: 919-469-0299
  • Fax:
Mailing address:
  • Phone: 919-469-0299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code1223X0008X
TaxonomyOral and Maxillofacial Radiology Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN S WON
Title or Position: OWNER
Credential: MD DDS PA
Phone: 919-469-0299