Healthcare Provider Details

I. General information

NPI: 1699914572
Provider Name (Legal Business Name): CAROLINA HEALTHCARE ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2009
Last Update Date: 03/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2131 S 17TH ST
WILMINGTON NC
28401-7407
US

IV. Provider business mailing address

PO BOX 602205
CHARLOTTE NC
28260-2205
US

V. Phone/Fax

Practice location:
  • Phone: 910-342-3001
  • Fax:
Mailing address:
  • Phone: 910-342-3001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number
License Number StateNC

VIII. Authorized Official

Name: MR. DANIEL L. WIENS
Title or Position: SR. VP
Credential:
Phone: 704-355-0648