Provider Demographics
NPI:1376513622
Name:FIRSTHEALTH DENTAL CARE CENTER
Entity Type:Organization
Organization Name:FIRSTHEALTH DENTAL CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:N
Authorized Official - Last Name:HARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS,MPH
Authorized Official - Phone:910-692-5111
Mailing Address - Street 1:314 TEAL DR
Mailing Address - Street 2:
Mailing Address - City:RAEFORD
Mailing Address - State:NC
Mailing Address - Zip Code:28376-2528
Mailing Address - Country:US
Mailing Address - Phone:910-904-7450
Mailing Address - Fax:910-904-7474
Practice Address - Street 1:314 TEAL DR
Practice Address - Street 2:
Practice Address - City:RAEFORD
Practice Address - State:NC
Practice Address - Zip Code:28376-2528
Practice Address - Country:US
Practice Address - Phone:910-904-7450
Practice Address - Fax:910-904-7474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCH0100261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89-015XVMedicaid