Provider Demographics
NPI:1558809210
Name:ANDREW R. PERNELL, DDS, PLLC
Entity Type:Organization
Organization Name:ANDREW R. PERNELL, DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:R
Authorized Official - Last Name:PERNELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:980-247-0040
Mailing Address - Street 1:275 N HIGHWAY 16
Mailing Address - Street 2:SUITE 101
Mailing Address - City:DENVER
Mailing Address - State:NC
Mailing Address - Zip Code:28037-3000
Mailing Address - Country:US
Mailing Address - Phone:980-247-0040
Mailing Address - Fax:
Practice Address - Street 1:12823 HERITAGE VISTA DR
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-6058
Practice Address - Country:US
Practice Address - Phone:828-310-7860
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-02
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty