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General NPI Number Information
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NPI Number | 1376595413
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Entity Type | Organization
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Legal Business Name | ROWAN ORAL & FACIAL SURGERY PC
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Dates
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Enumeration Date | 05/17/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 858 BRAWLEY SCHOOL RD SUITE C
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City | MOORESVILLE
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State | NC
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Zip | 28117-6852
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Country | US
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Telephone | 704-799-3555
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Fax | 704-799-3095
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Provider Business Mailing Address
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Address Line | 858 BRAWLEY SCHOOL RD SUITE C
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City | MOORESVILLE
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State | NC
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Zip | 28117-6852
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Country | US
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Telephone | 704-799-3555
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Fax | 704-799-3095
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Authorized Official
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Title or Position | PRESIDENT/SURGEON
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Name | JOHN A JOHNSON
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Credential | D.M.D., M.D.
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Telephone | 704-799-3555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State | NC
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