Healthcare Provider Details

I. General information

NPI: 1891412201
Provider Name (Legal Business Name): DANETTE OSBORNE SMART DDS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2022
Last Update Date: 10/26/2022
Certification Date: 10/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8220 UNIVERSITY EXEC PARK DR STE 105
CHARLOTTE NC
28262-1331
US

IV. Provider business mailing address

12829 CADGWITH COVE DR
HUNTERSVILLE NC
28078-5720
US

V. Phone/Fax

Practice location:
  • Phone: 704-549-8878
  • Fax:
Mailing address:
  • Phone: 704-978-9800
  • Fax:

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: AMANDA NOELLE GROESCHEL
Title or Position: DIRECTOR
Credential:
Phone: 704-978-9800