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NPI Code Detail

MEDICARE: LANDMARK DENTISTRY BIRKDALE

MEDICARE: LANDMARK DENTISTRY BIRKDALE
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
1122300000XDentistNC

General Provider Information

NPI Number : 1215350533
Entity Type Code : Organization
Provider Name (Legal Business Name) : LANDMARK DENTISTRY BIRKDALE
Provider Business Mailing Address
First Line : 8712 LINDHOLM DR
Second Line : SUITE 200
City : HUNTERSVILLE
State : NC
Zip : 28078-1870
Country : US
Telephone Number : 704-997-8280
Fax Number : 704-997-8274
Provider Business Practice Location Address
First Line : 8712 LINDHOLM DR
Second Line : SUITE 200
City : HUNTERSVILLE
State : NC
Zip : 28078-1870
Country : US
Telephone Number : 704-997-8280
Fax Number : 704-997-8274
Authorized Official
Title or Position : DENTIST
Name : MARK A. TRIPP
Credential : D.D.S.
Telephone Number : 704-997-8280
Provider Enumeration Date : 01/22/2014
Last Update Date : 01/22/2014

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Directions to “LANDMARK DENTISTRY BIRKDALE ” Practice Location

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