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General NPI Number Information
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NPI Number | 1144651605
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Entity Type | Organization
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Legal Business Name | SCHEETZ AND BACHARA FAMILY DENTISTRY
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Dates
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Enumeration Date | 12/10/2013
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Last Update Date | 12/10/2013
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Provider Practice Location Address
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Address Line | 1301 N HOWE ST
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City | SOUTHPORT
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State | NC
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Zip | 28461-2604
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Country | US
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Telephone | 910-457-5061
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Fax |
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Provider Business Mailing Address
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Address Line | 1301 N HOWE ST
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City | SOUTHPORT
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State | NC
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Zip | 28461-2604
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Country | US
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Telephone | 910-457-5061
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Fax |
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Authorized Official
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Title or Position | DENTIST/ BUSINESS OWNER
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Name | KURT THOMAS SCHEETZ
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Credential |
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Telephone | 910-457-5061
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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 | 8925
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 5788
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License Number State | NC
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