Healthcare Provider Details

I. General information

NPI: 1356329841
Provider Name (Legal Business Name): MONIQUE D MCEACHERN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10226 COULOAK DR STE 100
CHARLOTTE NC
28216-7675
US

IV. Provider business mailing address

10226 COULOAK DR STE 100
CHARLOTTE NC
28216-7675
US

V. Phone/Fax

Practice location:
  • Phone: 704-971-7272
  • Fax: 704-971-7522
Mailing address:
  • Phone: 704-971-7272
  • Fax: 704-971-7522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number7458
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: