Healthcare Provider Details

I. General information

NPI: 1306486436
Provider Name (Legal Business Name): ESHERE GBARBEA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2020
Last Update Date: 01/07/2020
Certification Date: 01/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9511 RIVERBEND VILLAGE DR STE 15
CHARLOTTE NC
28216-9123
US

IV. Provider business mailing address

9511 RIVERBEND VILLAGE DR STE 15
CHARLOTTE NC
28216-9123
US

V. Phone/Fax

Practice location:
  • Phone: 704-710-8162
  • Fax:
Mailing address:
  • Phone: 704-710-8162
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number11674
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: