Healthcare Provider Details

I. General information

NPI: 1992847842
Provider Name (Legal Business Name): STARLET MARIE CHAVIS OXENDINE DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

714 E. 4TH AVE
RED SPRINGS NC
28377
US

IV. Provider business mailing address

PO BOX 791
RED SPRINGS NC
28377-0791
US

V. Phone/Fax

Practice location:
  • Phone: 910-843-3353
  • Fax: 910-843-7240
Mailing address:
  • Phone: 910-843-3353
  • Fax: 910-843-7240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number8233
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: