Healthcare Provider Details

I. General information

NPI: 1881571644
Provider Name (Legal Business Name): PABLO PIEDRA PRIETO DMD
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2025
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 GEORGE W LILES PKWY NW
CONCORD NC
28027-2406
US

IV. Provider business mailing address

316 GEORGE W LILES PKWY NW
CONCORD NC
28027-2406
US

V. Phone/Fax

Practice location:
  • Phone: 980-393-8910
  • Fax:
Mailing address:
  • Phone: 980-393-8910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number14743
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: