=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457153447
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SERENA KANKASH DMD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/27/2025
-----------------------------------------------------
Last Update Date | 10/19/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2038 LITHO PL
-----------------------------------------------------
City | FAYETTEVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28304-2518
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-517-3067
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 726 N MAIN ST PMB 699
-----------------------------------------------------
City | FUQUAY VARINA
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27526-2029
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-346-4711
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | SERENA KANKASH
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 919-346-4711
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0221X
-----------------------------------------------------
Taxonomy Name | Pediatric Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------