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General NPI Number Information
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NPI Number | 1154564763
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Entity Type | Organization
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Legal Business Name | PARADISE FAMILY DENTISTRY
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Dates
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Enumeration Date | 04/13/2009
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Last Update Date | 04/13/2009
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Provider Practice Location Address
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Address Line | 104 W NORTHWOOD ST SUITE C
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City | GREENSBORO
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State | NC
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Zip | 27401-1326
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Country | US
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Telephone | 336-272-8087
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Fax | 336-272-8098
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Provider Business Mailing Address
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Address Line | 104 W NORTHWOOD ST SUITE C
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City | GREENSBORO
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State | NC
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Zip | 27401-1326
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Country | US
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Telephone | 336-272-8087
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Fax | 336-272-8098
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. DAVE ERSKINE FOULKES
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Credential | D.D.S.
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Telephone | 336-272-8087
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 7603
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License Number State | NC
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