Healthcare Provider Details

I. General information

NPI: 1215026943
Provider Name (Legal Business Name): DRS. PFEFFERLE AND KINDRACHUK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 02/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7800 SIX FORKS RD
RALEIGH NC
27615-2980
US

IV. Provider business mailing address

7800 SIX FORKS RD
RALEIGH NC
27615-2980
US

V. Phone/Fax

Practice location:
  • Phone: 919-847-5437
  • Fax:
Mailing address:
  • Phone: 919-847-5437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number7297
License Number StateNC

VIII. Authorized Official

Name: DON J KINDRACHUK
Title or Position: PARTNER
Credential: DMD
Phone: 919-847-5437