Provider Demographics
NPI:1376641233
Name:CASE, JACK C JR (DDS,MS)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:C
Last Name:CASE
Suffix:JR
Gender:M
Credentials:DDS,MS
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Mailing Address - Street 1:2711 RANDOLPH RD
Mailing Address - Street 2:SUITE 600
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28207-2034
Mailing Address - Country:US
Mailing Address - Phone:704-334-7202
Mailing Address - Fax:704-372-2690
Practice Address - Street 1:2711 RANDOLPH RD
Practice Address - Street 2:SUITE 600
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-2034
Practice Address - Country:US
Practice Address - Phone:704-334-7202
Practice Address - Fax:704-372-2690
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC2000012246341223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics