Provider Demographics
NPI:1043413867
Name:NORTH CAROLINA CENTER FOR ORAL & MAXILLOFACIAL SURGERY
Entity Type:Organization
Organization Name:NORTH CAROLINA CENTER FOR ORAL & MAXILLOFACIAL SURGERY
Other - Org Name:CENTRAL DURHAM ORAL &MAXILLOFACIAL SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SPENCER
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:919-306-2252
Mailing Address - Street 1:7606 MORRELL LN
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-6665
Mailing Address - Country:US
Mailing Address - Phone:919-544-5789
Mailing Address - Fax:
Practice Address - Street 1:415 -B DUNSTAN
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-2321
Practice Address - Country:US
Practice Address - Phone:919-682-4667
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC76141223S0112X
NC73811223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty