Provider Demographics
NPI:1639195241
Name:MECKLENBURG COUNTY
Entity Type:Organization
Organization Name:MECKLENBURG COUNTY
Other - Org Name:MECKLENBURG COUNTY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HEALTH DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EARL
Authorized Official - Middle Name:WINTERS
Authorized Official - Last Name:MABRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-336-2299
Mailing Address - Street 1:1801 ROZZELLES FERRY RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28208-4228
Mailing Address - Country:US
Mailing Address - Phone:704-350-7305
Mailing Address - Fax:704-350-7304
Practice Address - Street 1:1801 ROZZELLES FERRY RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28208-4228
Practice Address - Country:US
Practice Address - Phone:704-350-7305
Practice Address - Fax:704-350-7304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0001XDental ProvidersDentistDental Public HealthGroup - Single Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or LocalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC015N0OtherNC HEALTH CHOICE GROUP #
NC89015N0Medicaid