Healthcare Provider Details

I. General information

NPI: 1578139499
Provider Name (Legal Business Name): LINER, WARD & SHOBE DDS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2021
Last Update Date: 02/28/2024
Certification Date: 02/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1370 PIEDMONT DR STE 200
LEXINGTON NC
27295-2053
US

IV. Provider business mailing address

6570 SHALLOWFORD RD
LEWISVILLE NC
27023-8651
US

V. Phone/Fax

Practice location:
  • Phone: 336-249-9100
  • Fax:
Mailing address:
  • Phone: 336-945-5555
  • Fax: 336-945-0125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MRS. DACIA K EILERT-HOLCOMB
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 336-945-5555