Healthcare Provider Details

I. General information

NPI: 1689058026
Provider Name (Legal Business Name): AMY RENEE SEXTON D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2015
Last Update Date: 10/10/2022
Certification Date: 10/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

877 E GANNON AVE SUITE 401
ZEBULON NC
27597-9314
US

IV. Provider business mailing address

877 E GANNON AVE STE 401
ZEBULON NC
27597-9445
US

V. Phone/Fax

Practice location:
  • Phone: 919-215-5686
  • Fax:
Mailing address:
  • Phone: 919-215-5686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number10336
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number057914-1
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number10336
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: