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General NPI Number Information
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NPI Number | 1780891259
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Entity Type | Organization
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Legal Business Name | RALPH R. EDDY JR. D. D. S.
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Dates
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Enumeration Date | 05/16/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 513 WHITE OAK ST
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City | ASHEBORO
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State | NC
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Zip | 27203-4770
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Country | US
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Telephone | 336-629-7095
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Fax |
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Provider Business Mailing Address
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Address Line | 513 WHITE OAK ST
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City | ASHEBORO
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State | NC
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Zip | 27203-4770
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Country | US
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Telephone | 336-629-7095
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. RALPH ROTHWELL EDDY JR.
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Credential | D.D.S.
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Telephone | 336-629-7095
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 4762
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License Number State | NC
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