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NPI Code Detail

MEDICARE: MRS. SANDRA MARTIN BUMGARNER RDH

MEDICARE: MRS. SANDRA MARTIN BUMGARNER RDH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1124Q00000XDental Hygienist3827NC

General Provider Information

NPI Number : 1174686984
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. SANDRA MARTIN BUMGARNER RDH
Provider Business Mailing Address
First Line : 908 N SANDHILLS BLVD
Second Line :
City : ABERDEEN
State : NC
Zip : 28315-2547
Country : US
Telephone Number : 910-944-5600
Fax Number : 910-944-9334
Provider Business Practice Location Address
First Line : 908 N SANDHILLS BLVD
Second Line :
City : ABERDEEN
State : NC
Zip : 28315-2547
Country : US
Telephone Number : 910-944-5600
Fax Number : 910-944-9334
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/19/2006
Last Update Date : 07/08/2007

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Directions to “ MRS. SANDRA MARTIN BUMGARNER RDH” Practice Location

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