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General NPI Number Information
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NPI Number | 1508878828
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Entity Type | Organization
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Legal Business Name | CAROLINAS MOBILE DENTISTRY
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Dates
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Enumeration Date | 08/13/2006
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Last Update Date | 01/28/2008
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Provider Practice Location Address
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Address Line | 1000 BLYTHE BLVD MEDICAL EDUCATION BUILDING, 2ND FLOOR
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City | CHARLOTTE
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State | NC
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Zip | 28203-5812
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Country | US
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Telephone | 704-355-5317
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Fax | 704-355-0714
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Provider Business Mailing Address
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Address Line | PO BOX 36154
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City | CHARLOTTE
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State | NC
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Zip | 28236-6154
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Country | US
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Telephone | 704-355-5317
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Fax | 704-355-0714
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Authorized Official
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Title or Position | SENIOR VICE PRESIDENT
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Name | DANIEL L WIENS
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Credential |
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Telephone | 704-355-0648
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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