Healthcare Provider Details

I. General information

NPI: 1568302503
Provider Name (Legal Business Name): SOUTHERN OAKS DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2090 WATERSCAPE WAY
NEW BERN NC
28562-7097
US

IV. Provider business mailing address

2090 WATERSCAPE WAY
NEW BERN NC
28562-7097
US

V. Phone/Fax

Practice location:
  • Phone: 252-631-3260
  • Fax:
Mailing address:
  • Phone: 252-631-3260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. DALAS YOUNG
Title or Position: PRESIDENT
Credential: DMD
Phone: 252-702-5399