Healthcare Provider Details

I. General information

NPI: 1861031874
Provider Name (Legal Business Name): AFTON ENDODONTICS LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2019
Last Update Date: 01/02/2020
Certification Date: 01/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5345 VINING ST NW STE 201
CONCORD NC
28027-2938
US

IV. Provider business mailing address

5345 VINNING ST NW STE 201
CONCORD NC
28027-2938
US

V. Phone/Fax

Practice location:
  • Phone: 704-784-4625
  • Fax: 704-793-4647
Mailing address:
  • Phone: 704-784-4625
  • Fax: 704-793-4647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. GREGORY GELL
Title or Position: OWNER
Credential: DDS, MS
Phone: 704-784-4625