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General NPI Number Information
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NPI Number | 1821555020
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Entity Type | Organization
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Legal Business Name | SURGICAL CENTER FOR DENTAL PROFESSIONALS OF NC LLC
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Dates
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Enumeration Date | 02/23/2019
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Last Update Date | 05/30/2024
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Provider Practice Location Address
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Address Line | 2620 NEW BERN AVE
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City | RALEIGH
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State | NC
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Zip | 27610-1821
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Country | US
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Telephone | 919-526-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 2620 NEW BERN AVE
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City | RALEIGH
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State | NC
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Zip | 27610-1821
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Country | US
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Telephone | 919-526-1000
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. DEVIN LARSEN
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Credential |
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Telephone | 208-340-1840
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 367H00000X
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Taxonomy Name | Anesthesiologist Assistant
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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