Provider Demographics
NPI:1609076074
Name:WAKE CROSS ROADS DENTISTRY
Entity Type:Organization
Organization Name:WAKE CROSS ROADS DENTISTRY
Other - Org Name:DAVID C. DILLARD, D.D.S.,P.L.L.C
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:CONRAD
Authorized Official - Last Name:DILLARD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:919-453-0777
Mailing Address - Street 1:4008 MITCHELL MILL ROAD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27616
Mailing Address - Country:US
Mailing Address - Phone:919-453-0777
Mailing Address - Fax:919-453-0774
Practice Address - Street 1:4008 MITCHELL MILL ROAD
Practice Address - Street 2:SUITE 108
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27616
Practice Address - Country:US
Practice Address - Phone:919-453-0777
Practice Address - Fax:919-453-0774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-23
Last Update Date:2009-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7970261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental