Provider Demographics
NPI:1568953297
Name:FORD, PRESTON LEE (DDS)
Entity Type:Individual
Prefix:
First Name:PRESTON
Middle Name:LEE
Last Name:FORD
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 1:4416 YANCEYVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BROWNS SUMMIT
Mailing Address - State:NC
Mailing Address - Zip Code:27214-9206
Mailing Address - Country:US
Mailing Address - Phone:336-601-8033
Mailing Address - Fax:
Practice Address - Street 1:6161 LAKE BRANDT RD UNIT A
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27455-8415
Practice Address - Country:US
Practice Address - Phone:336-643-1440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-29
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10994122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist