Provider Demographics
NPI:1437898046
Name:MOHR, FELIPE JUNGBLUT (DDS)
Entity Type:Individual
Prefix:
First Name:FELIPE
Middle Name:JUNGBLUT
Last Name:MOHR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 BARLEY STONE WAY
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27603-5194
Mailing Address - Country:US
Mailing Address - Phone:636-448-4658
Mailing Address - Fax:
Practice Address - Street 1:2050 SKIBO RD STE 104
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28314-3161
Practice Address - Country:US
Practice Address - Phone:910-605-4106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-01
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NC128921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program