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General NPI Number Information
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NPI Number | 1124568100
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Entity Type | Individual
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Provider Name | NEIZEL SONGALIA DURANT
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Gender | Female
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Dates
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Enumeration Date | 02/24/2017
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Last Update Date | 08/06/2024
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Provider Practice Location Address
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Address Line | 2831 MIDWAY RD SE STE 116
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City | BOLIVIA
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State | NC
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Zip | 28422-8377
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Country | US
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Telephone | 910-408-4436
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Fax |
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Provider Business Mailing Address
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Address Line | 103 BLACKGUM CT
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City | MAULDIN
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State | SC
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Zip | 29662
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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 |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 11662
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License Number State | NC
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