Provider Demographics
NPI:1699201830
Name:COUNTY OF GRAHAM
Entity Type:Organization
Organization Name:COUNTY OF GRAHAM
Other - Org Name:DPH DENTAL
Other - Org Type:Other Name
Authorized Official - Title/Position:FINANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:
Authorized Official - Last Name:CARPENTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-479-7770
Mailing Address - Street 1:PO BOX 1848
Mailing Address - Street 2:
Mailing Address - City:ROBBINSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28771-1848
Mailing Address - Country:US
Mailing Address - Phone:828-479-7900
Mailing Address - Fax:828-479-7902
Practice Address - Street 1:21 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ROBBINSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28771-9054
Practice Address - Country:US
Practice Address - Phone:828-479-7900
Practice Address - Fax:828-479-7902
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF GRAHAM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-05-09
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8743261QD0000X
261QP0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3404338Medicaid