MEDICARE: DR. CHARLES RICHARDSON BIGGERSTAFF DDS, PHARMD

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	8379	NC

General Provider Information

NPI Number	:	1790987774
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES RICHARDSON BIGGERSTAFF DDS, PHARMD

Provider Business Mailing Address
First Line	:	4233 PINE HOLLOW RD
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28412-2271
Country	:	US
Telephone Number	:	910-350-2569
Fax Number	:

Provider Business Practice Location Address
First Line	:	1300 S DICKINSON DR
Second Line	:
City	:	LELAND
State	:	NC
Zip	:	28451-6430
Country	:	US
Telephone Number	:	910-383-2615
Fax Number	:	910-383-2618

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

Provider Enumeration Date	:	06/02/2007
Last Update Date	:	12/09/2019

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