Healthcare Provider Details

I. General information

NPI: 1811033137
Provider Name (Legal Business Name): CAROLINAS ORAL & FACIAL SURGERY CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 04/04/2024
Certification Date: 04/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 PHYSICIANS DR
WILMINGTON NC
28401-7352
US

IV. Provider business mailing address

1305 PHYSICIANS DR
WILMINGTON NC
28401-7352
US

V. Phone/Fax

Practice location:
  • Phone: 910-762-2618
  • Fax: 910-763-5173
Mailing address:
  • Phone: 910-762-2618
  • Fax: 910-763-5173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: ANDREA RHODES
Title or Position: COO
Credential:
Phone: 910-762-2618