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General NPI Number Information
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NPI Number | 1265604193
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Entity Type | Organization
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Legal Business Name | HOLLY SPRINGS FAMILY DENTISTRY
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Dates
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Enumeration Date | 04/01/2008
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Last Update Date | 08/19/2008
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Provider Practice Location Address
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Address Line | 190 ROSEWOOD CENTER DRIVE SUITE 200
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City | HOLLY SPRINGS
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State | NC
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Zip | 27540
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Country | US
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Telephone | 919-290-2772
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Fax | 919-270-2773
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Provider Business Mailing Address
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Address Line | 190 ROSEWOOD CENTER DRIVE SUITE 200
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City | HOLLY SPRINGS
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State | NC
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Zip | 27540
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Country | US
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Telephone | 919-290-2772
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Fax | 919-270-2773
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | MR. MATTHEW AUSTIN TAYLOR
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Credential |
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Telephone | 919-290-2772
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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 | 7601
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License Number State | NC
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