Healthcare Provider Details

I. General information

NPI: 1891898060
Provider Name (Legal Business Name): DRS. ENGLEHARDT & VANDE BERG, DDS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 HIGH HOUSE RD SUITE 100
CARY NC
27513-3576
US

IV. Provider business mailing address

1010 HIGH HOUSE RD SUITE 100
CARY NC
27513-3576
US

V. Phone/Fax

Practice location:
  • Phone: 919-461-0110
  • Fax: 919-461-0114
Mailing address:
  • Phone: 919-461-0110
  • Fax: 919-461-0114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number StateNC

VIII. Authorized Official

Name: MS. KARLA W. GRANTHAM
Title or Position: OFFICE MANAGER
Credential:
Phone: 919-461-0110