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General NPI Number Information
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NPI Number | 1063617199
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Entity Type | Organization
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Legal Business Name | GRADUATE ORTHODONTICS CLINIC
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Dates
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Enumeration Date | 06/19/2007
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Last Update Date | 06/18/2008
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Provider Practice Location Address
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Address Line | CB 7450 OLD DENTAL BLDG
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City | CHAPEL HILL
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State | NC
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Zip | 27599-0001
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Country | US
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Telephone | 919-966-2769
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Fax |
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Provider Business Mailing Address
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Address Line | CB 7450 OLD DENTAL BLDG
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City | CHAPEL HILL
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State | NC
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Zip | 27599-0001
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER, ORTHODONTICS
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Name | FAITH PATTERSON
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Credential |
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Telephone | 919-966-2769
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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