Healthcare Provider Details

I. General information

NPI: 1518045079
Provider Name (Legal Business Name): SCOTT A TURIK DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 EAST SECOND ST POB 483
KENLY NC
27542
US

IV. Provider business mailing address

409 EAST SECOND ST POB 483
KENLY NC
27542
US

V. Phone/Fax

Practice location:
  • Phone: 919-284-2254
  • Fax:
Mailing address:
  • Phone: 919-284-2254
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5194
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: