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General NPI Number Information
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NPI Number | 1265911705
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Entity Type | Organization
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Legal Business Name | SOUTHSIDE UNITED HEALTH CENTERS
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Dates
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Enumeration Date | 08/07/2018
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Last Update Date | 03/01/2022
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Provider Practice Location Address
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Address Line | 2101 PETERS CREEK PKWY
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City | WINSTON SALEM
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State | NC
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Zip | 27127
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Country | US
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Telephone | 336-955-1379
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Fax | 336-893-9987
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Provider Business Mailing Address
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Address Line | PO BOX 12341
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City | WINSTON SALEM
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State | NC
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Zip | 27117-2341
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Country | US
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Telephone | 336-955-1379
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Fax | 336-893-9987
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Authorized Official
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Title or Position | FINANCE DIRECTOR
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Name | CRE'SHAWNA WHITE
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Credential |
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Telephone | 336-529-2163
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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 |
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License Number State | NC
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