Provider Demographics
NPI:1164912093
Name:CARY DENTAL REJUVENATION
Entity Type:Organization
Organization Name:CARY DENTAL REJUVENATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BIKRAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SIGNH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:919-460-5454
Mailing Address - Street 1:155 PARKWAY OFFICE COURT
Mailing Address - Street 2:SUITE 104
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518
Mailing Address - Country:US
Mailing Address - Phone:919-460-5454
Mailing Address - Fax:919-460-3939
Practice Address - Street 1:155 PARKWAY OFFICE COURT
Practice Address - Street 2:SUITE 104
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518
Practice Address - Country:US
Practice Address - Phone:919-460-5454
Practice Address - Fax:919-460-3939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-16
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC090691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty