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General NPI Number Information
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NPI Number | 1306894597
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Entity Type | Organization
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Legal Business Name | MACON, COLLIE, PRETZER, KORNSTEIN AND HICKS DDS
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Dates
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Enumeration Date | 05/04/2006
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Last Update Date | 10/05/2023
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Provider Practice Location Address
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Address Line | 7401 CREEDMOOR RD
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City | RALEIGH
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State | NC
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Zip | 27613-1640
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Country | US
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Telephone | 919-848-3588
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Fax | 919-846-3550
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Provider Business Mailing Address
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Address Line | 7401 CREEDMOOR RD
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City | RALEIGH
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State | NC
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Zip | 27613-1640
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Country | US
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Telephone | 919-848-3588
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Fax | 919-846-3550
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | LINDA TARANTINO
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Credential |
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Telephone | 919-719-1780
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 2934
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License Number State | NC
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