Provider Demographics
NPI:1659956597
Name:DUAL IMAGE DENTISTRY & ORTHODONTICS
Entity Type:Organization
Organization Name:DUAL IMAGE DENTISTRY & ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LINDSEY
Authorized Official - Middle Name:
Authorized Official - Last Name:SALONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-334-6907
Mailing Address - Street 1:1315 MATHESON AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205-1670
Mailing Address - Country:US
Mailing Address - Phone:704-334-6907
Mailing Address - Fax:
Practice Address - Street 1:1315 MATHESON AVE
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28205-1670
Practice Address - Country:US
Practice Address - Phone:704-334-6907
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-12
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental