Provider Demographics
NPI:1831488493
Name:ASHEBORO FAMILY DENTISTRY
Entity Type:Organization
Organization Name:ASHEBORO FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LIONEL
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:SR
Authorized Official - Credentials:DMD
Authorized Official - Phone:919-489-0497
Mailing Address - Street 1:350 N. COX STREET
Mailing Address - Street 2:SUITE 11
Mailing Address - City:ASHEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27203-5514
Mailing Address - Country:US
Mailing Address - Phone:336-629-6488
Mailing Address - Fax:336-629-4441
Practice Address - Street 1:350 N. COX STREET
Practice Address - Street 2:SUITE 11
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203-5514
Practice Address - Country:US
Practice Address - Phone:336-629-6488
Practice Address - Fax:336-629-4441
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIONEL NELSON DENTISTRY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-04-05
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC71581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty