Provider Demographics
NPI:1154477925
Name:COUNTY OF CATAWBA
Entity Type:Organization
Organization Name:COUNTY OF CATAWBA
Other - Org Name:CATAWBA COUNTY PUBLIC HEALTH DENTAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HEALTH DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:W
Authorized Official - Last Name:URLAND
Authorized Official - Suffix:
Authorized Official - Credentials:MPA
Authorized Official - Phone:828-695-5801
Mailing Address - Street 1:3070 11TH AVENUE DR SE
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-8336
Mailing Address - Country:US
Mailing Address - Phone:828-695-5849
Mailing Address - Fax:828-695-4410
Practice Address - Street 1:3070 11TH AVENUE DR SE
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-8336
Practice Address - Country:US
Practice Address - Phone:828-695-5849
Practice Address - Fax:828-695-4410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC261QD0000X, 261QP0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Not Answered261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3404426Medicaid
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