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General NPI Number Information
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NPI Number | 1639559016
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Entity Type | Organization
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Legal Business Name | LUKE K. DALZELL, DDS, PLLC
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Dates
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Enumeration Date | 06/01/2015
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Last Update Date | 06/01/2015
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Provider Practice Location Address
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Address Line | 5710 SIX FORKS RD STE 101
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City | RALEIGH
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State | NC
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Zip | 27609-8617
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Country | US
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Telephone | 706-604-9144
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Fax |
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Provider Business Mailing Address
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Address Line | 5710 SIX FORKS RD STE 101
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City | RALEIGH
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State | NC
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Zip | 27609-8617
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Country | US
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Telephone | 706-604-9144
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Fax |
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Authorized Official
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Title or Position | ENDODONTIST/OWNER
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Name | DR. LUKE K. DALZELL
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Credential | D.D.S.
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Telephone | 706-604-9144
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 9892
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License Number State | NC
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