Provider Demographics
NPI:1467443044
Name:DEARSTYNE, MICHAEL R (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:R
Last Name:DEARSTYNE
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 1:835 WAKE FOREST BUSINESS PARK
Mailing Address - Street 2:SUITE E
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-7324
Mailing Address - Country:US
Mailing Address - Phone:919-570-7930
Mailing Address - Fax:919-570-0954
Practice Address - Street 1:835 WAKE FOREST BUSINESS PARK
Practice Address - Street 2:SUITE E
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-7324
Practice Address - Country:US
Practice Address - Phone:919-570-7930
Practice Address - Fax:919-570-0954
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC39121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice