Healthcare Provider Details

I. General information

NPI: 1508997883
Provider Name (Legal Business Name): CAROLINA SURGICAL ARTS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 01/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2516 OAKCREST AVE SUITE B
GREENSBORO NC
27408-1932
US

IV. Provider business mailing address

2516 OAKCREST AVE SUITE B
GREENSBORO NC
27408-1932
US

V. Phone/Fax

Practice location:
  • Phone: 336-288-0677
  • Fax: 336-288-0784
Mailing address:
  • Phone: 336-288-0677
  • Fax: 336-288-0784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number34801
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number34801
License Number StateNC

VIII. Authorized Official

Name: TODD GENE OWSLEY
Title or Position: PRESIDENT
Credential: MD
Phone: 336-288-0677