Healthcare Provider Details

I. General information

NPI: 1881052025
Provider Name (Legal Business Name): CAROLINA VERA RESENDIZ D.D.S,MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2016
Last Update Date: 02/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 MANNING DR CAMPUS BOX 7450
CHAPEL HILL NC
27514-4220
US

IV. Provider business mailing address

21 TWINLEAF PL
DURHAM NC
27705-1956
US

V. Phone/Fax

Practice location:
  • Phone: 919-428-0522
  • Fax:
Mailing address:
  • Phone: 919-428-0522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number9908
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: