Provider Demographics
NPI:1871035188
Name:NUANCE FACIAL PLASTICS PLLC
Entity Type:Organization
Organization Name:NUANCE FACIAL PLASTICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUMMIT
Authorized Official - Middle Name:BHANJI
Authorized Official - Last Name:KUNDARIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-593-6802
Mailing Address - Street 1:309 S SHARON AMITY RD
Mailing Address - Street 2:STE 202
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-2978
Mailing Address - Country:US
Mailing Address - Phone:704-593-6802
Mailing Address - Fax:980-859-2784
Practice Address - Street 1:309 S SHARON AMITY RD
Practice Address - Street 2:STE 202
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-2978
Practice Address - Country:US
Practice Address - Phone:704-593-6802
Practice Address - Fax:980-859-2784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-17
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2016-01378261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty