Provider Demographics
NPI:1679010011
Name:TRIANGLE PLASTIC SURGERY CENTER, PLLC
Entity Type:Organization
Organization Name:TRIANGLE PLASTIC SURGERY CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LONNIE
Authorized Official - Middle Name:W
Authorized Official - Last Name:BUNN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-706-4900
Mailing Address - Street 1:9104 FALLS OF NEUSE RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-2494
Mailing Address - Country:US
Mailing Address - Phone:919-706-4900
Mailing Address - Fax:919-706-4901
Practice Address - Street 1:9104 FALLS OF NEUSE RD
Practice Address - Street 2:SUITE 204
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-2494
Practice Address - Country:US
Practice Address - Phone:919-706-4900
Practice Address - Fax:919-706-4901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-24
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200900778207YS0123X
NC2011000555208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
No207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic SurgeryGroup - Multi-Specialty