Provider Demographics
NPI:1689092033
Name:ASHEVILLE FAMILY DENTISTRY
Entity Type:Organization
Organization Name:ASHEVILLE FAMILY DENTISTRY
Other - Org Name:DBA ASHEVILLE FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:CALLAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:828-299-4455
Mailing Address - Street 1:1011 TUNNEL RD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28805-2058
Mailing Address - Country:US
Mailing Address - Phone:828-299-4455
Mailing Address - Fax:828-299-0550
Practice Address - Street 1:1011 TUNNEL RD
Practice Address - Street 2:SUITE 140
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28805-2058
Practice Address - Country:US
Practice Address - Phone:828-299-4455
Practice Address - Fax:828-299-0550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-02
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8614122300000X
NC8622122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty