MEDICARE: DYNAMIC CONNECTIONS PLLC

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	261QH0700X	Hearing and Speech Clinic/Center	C201412600370-1	NC

General Provider Information

NPI Number	:	1861808065
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DYNAMIC CONNECTIONS PLLC

Provider Business Mailing Address
First Line	:	PO BOX 25863
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28314-5014
Country	:	US
Telephone Number	:	910-364-7006
Fax Number	:

Provider Business Practice Location Address
First Line	:	2612 THORNGROVE CT
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28303-2883
Country	:	US
Telephone Number	:	910-364-7006
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CHRISTAL CARTER
Credential	:	CCC-SLP
Telephone Number	:	910-364-7006

Provider Enumeration Date	:	07/08/2014
Last Update Date	:	07/08/2014

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