Healthcare Provider Details

I. General information

NPI: 1477654242
Provider Name (Legal Business Name): DRS HULL, BURROW, CASE & COLEMAN PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2711 RANDOLPH RD SUITE #600
CHARLOTTE NC
28207
US

IV. Provider business mailing address

2711 RANDOLPH RD SUITE #600
CHARLOTTE NC
28207
US

V. Phone/Fax

Practice location:
  • Phone: 704-334-7202
  • Fax: 704-372-2690
Mailing address:
  • Phone: 704-334-7202
  • Fax: 704-372-2690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MRS. PATTY D STUMPF
Title or Position: ADMINISTRATOR
Credential:
Phone: 704-334-7202