Provider Demographics
NPI:1609265842
Name:CAROLINA COMFORT DENTAL
Entity Type:Organization
Organization Name:CAROLINA COMFORT DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:SEAN
Authorized Official - Last Name:O'BRIEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:910-485-0023
Mailing Address - Street 1:5511 RAEFORD RD
Mailing Address - Street 2:SUITE #225
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-2057
Mailing Address - Country:US
Mailing Address - Phone:910-485-0023
Mailing Address - Fax:
Practice Address - Street 1:5511 RAEFORD RD
Practice Address - Street 2:SUITE #225
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-2057
Practice Address - Country:US
Practice Address - Phone:910-485-0023
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-12
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty