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General NPI Number Information
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NPI Number | 1194481051
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Entity Type | Organization
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Legal Business Name | DAVID WOOLSTON DDS PLLC
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Dates
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Enumeration Date | 11/15/2021
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Last Update Date | 11/15/2021
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Provider Practice Location Address
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Address Line | 2120 DR WEBBER AVE
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City | CHARLOTTE
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State | NC
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Zip | 28216-4898
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Country | US
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Telephone | 704-392-9357
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Fax |
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Provider Business Mailing Address
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Address Line | 2120 DR WEBBER AVE
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City | CHARLOTTE
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State | NC
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Zip | 28216-4898
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Country | US
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Telephone | 704-392-9357
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Fax |
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Authorized Official
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Title or Position | CHIEF OPERATIONS OFFICER
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Name | MR. RONALD DANIEL SERRAO
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Credential |
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Telephone | 980-316-7102
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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