Provider Demographics
NPI:1609047356
Name:DIGITAL DENTISTRY @ SOUTHPOINT
Entity Type:Organization
Organization Name:DIGITAL DENTISTRY @ SOUTHPOINT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:WADE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-383-8812
Mailing Address - Street 1:249 EAST NC 54 HIGHWAY
Mailing Address - Street 2:SUITE 220
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713
Mailing Address - Country:US
Mailing Address - Phone:919-383-8812
Mailing Address - Fax:919-383-8904
Practice Address - Street 1:249 EAST NC 54 HIGHWAY
Practice Address - Street 2:SUITE 220
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713
Practice Address - Country:US
Practice Address - Phone:919-383-8812
Practice Address - Fax:919-383-8904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-20
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC56771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty