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General NPI Number Information
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NPI Number | 1457565848
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Entity Type | Organization
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Legal Business Name | GREATER CHARLOTTE ORAL AND FACIAL SURGERY
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Dates
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Enumeration Date | 05/09/2007
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Last Update Date | 10/13/2014
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Provider Practice Location Address
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Address Line | 10035 PARK CEDAR DR SUITE 300
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City | CHARLOTTE
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State | NC
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Zip | 28210-8911
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Country | US
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Telephone | 704-542-9600
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Fax | 704-542-9651
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Provider Business Mailing Address
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Address Line | 10035 PARK CEDAR DR SUITE 300
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City | CHARLOTTE
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State | NC
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Zip | 28210-8911
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Country | US
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Telephone | 704-542-9600
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Fax | 704-542-9651
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. AMIR H MARASHI
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Credential | MD
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Telephone | 704-542-9600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 01124
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License Number State | NC
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