Provider Demographics
NPI:1215026943
Name:DRS. PFEFFERLE AND KINDRACHUK
Entity Type:Organization
Organization Name:DRS. PFEFFERLE AND KINDRACHUK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:DON
Authorized Official - Middle Name:J
Authorized Official - Last Name:KINDRACHUK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:919-847-5437
Mailing Address - Street 1:7800 SIX FORKS RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-2980
Mailing Address - Country:US
Mailing Address - Phone:919-847-5437
Mailing Address - Fax:
Practice Address - Street 1:7800 SIX FORKS RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-2980
Practice Address - Country:US
Practice Address - Phone:919-847-5437
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC72971223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5901969Medicaid