=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912024308
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SMALL AND PIERS LLP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/23/2007
-----------------------------------------------------
Last Update Date | 01/19/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 110 JUNIPER ST STE 300
-----------------------------------------------------
City | MORGANTON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28655-4677
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-433-1242
-----------------------------------------------------
Fax | 828-437-3899
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 110 JUNIPER ST STE 300
-----------------------------------------------------
City | MORGANTON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28655-4677
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-433-1242
-----------------------------------------------------
Fax | 828-437-3899
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. DAVID SMALL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 828-433-1242
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number | 7232
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------