Provider Demographics
NPI:1053442210
Name:LINER, WARD & SHOBE DDS, PA
Entity Type:Organization
Organization Name:LINER, WARD & SHOBE DDS, PA
Other - Org Name:SOUTHERN DENTAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DACIA
Authorized Official - Middle Name:K
Authorized Official - Last Name:EILERT-HOLCOMB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-945-5555
Mailing Address - Street 1:1690 RIVER ST
Mailing Address - Street 2:
Mailing Address - City:WILKESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28697-7630
Mailing Address - Country:US
Mailing Address - Phone:336-838-9400
Mailing Address - Fax:336-838-1872
Practice Address - Street 1:1690 RIVER ST
Practice Address - Street 2:
Practice Address - City:WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28697-7630
Practice Address - Country:US
Practice Address - Phone:336-838-9400
Practice Address - Fax:336-838-1872
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LINER, WARD & SHOBE DDS, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
122300000X
NC1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty