Provider Demographics
NPI:1659317394
Name:SHOLAR, AXON DARREN (DDS)
Entity Type:Individual
Prefix:
First Name:AXON
Middle Name:DARREN
Last Name:SHOLAR
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 1:522 S NORWOOD ST
Mailing Address - Street 2:
Mailing Address - City:WALLACE
Mailing Address - State:NC
Mailing Address - Zip Code:28466
Mailing Address - Country:US
Mailing Address - Phone:910-285-7800
Mailing Address - Fax:910-285-6097
Practice Address - Street 1:522 S NORWOOD ST
Practice Address - Street 2:
Practice Address - City:WALLACE
Practice Address - State:NC
Practice Address - Zip Code:28466
Practice Address - Country:US
Practice Address - Phone:910-285-7800
Practice Address - Fax:910-285-6097
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC62681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8997800Medicaid
NC97800OtherBLUE CROSS BLUE SHIELD
358397OtherTRIGON
1680308OtherUNITED CONCORDIA