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General NPI Number Information
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NPI Number | 1336473982
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Entity Type | Organization
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Legal Business Name | BETANCOURT, PINNIX, PHELPS, & GRIMES DMD PLLC
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Dates
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Enumeration Date | 09/30/2009
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Last Update Date | 09/30/2009
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Provider Practice Location Address
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Address Line | 400 PARKWOOD MEDICAL PARK
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City | ELKIN
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State | NC
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Zip | 28621-2485
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Country | US
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Telephone | 336-835-5579
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Fax | 336-835-2639
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Provider Business Mailing Address
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Address Line | 400 PARKWOOD MEDICAL PARK
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City | ELKIN
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State | NC
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Zip | 28621-2485
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Country | US
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Telephone | 336-835-5579
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Fax | 336-835-2639
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Authorized Official
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Title or Position | COPRESIDENT
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Name | DR. CHRISTOPHER LATHAM PHELPS
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Credential | DMD
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Telephone | 704-845-1107
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 7648
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License Number State | NC
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