Provider Demographics
NPI:1306401948
Name:CAROLINAS CENTER FOR DENTAL IMPLANTS
Entity Type:Organization
Organization Name:CAROLINAS CENTER FOR DENTAL IMPLANTS
Other - Org Name:ENVISION DENTAL IMPLANT CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF CONTRACTING AND CREDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:RAYLE
Authorized Official - Last Name:HOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-295-4653
Mailing Address - Street 1:5550 77 CENTER DR STE 320
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28217-0739
Mailing Address - Country:US
Mailing Address - Phone:704-295-4653
Mailing Address - Fax:704-295-4288
Practice Address - Street 1:280 ROCKY SLOPE RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-3908
Practice Address - Country:US
Practice Address - Phone:864-252-9464
Practice Address - Fax:864-482-7510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-09
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty