MEDICARE: BIRKDALE FAMILY AND COSMETIC DENTISTRY

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	8141	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396084216
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BIRKDALE FAMILY AND COSMETIC DENTISTRY

Provider Business Mailing Address
First Line	:	8712 LINDHOLM DR
Second Line	:	SUITE 200
City	:	HUNTERSVILLE
State	:	NC
Zip	:	28078-1870
Country	:	US
Telephone Number	:
Fax Number	:

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	:	704-896-5225
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LARRY COMPTON
Credential	:
Telephone Number	:	704-896-5225

Provider Enumeration Date	:	02/13/2013
Last Update Date	:	02/13/2013

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