MEDICARE: DR. MICHAEL ODELL GIVENS D.D.S.

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
1	1223G0001X	General Practice Dentistry	5082	NC

General Provider Information

NPI Number	:	1235167651
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL ODELL GIVENS D.D.S.

Provider Business Mailing Address
First Line	:	9100 PLEASANT RIDGE RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28215-9710
Country	:	US
Telephone Number	:	704-564-5981
Fax Number	:

Provider Business Practice Location Address
First Line	:	8305 UNIVERSITY EXEC PARK DR STE 300
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28262-3357
Country	:	US
Telephone Number	:	704-547-1279
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2006
Last Update Date	:	07/14/2020

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