Provider Demographics
NPI:1891898060
Name:DRS. ENGLEHARDT & VANDE BERG, DDS, PA
Entity Type:Organization
Organization Name:DRS. ENGLEHARDT & VANDE BERG, DDS, PA
Other - Org Name:DRS. ENGLEHARDT & VANDE BERG, DDS, PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KARLA
Authorized Official - Middle Name:W
Authorized Official - Last Name:GRANTHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-461-0110
Mailing Address - Street 1:1010 HIGH HOUSE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-3576
Mailing Address - Country:US
Mailing Address - Phone:919-461-0110
Mailing Address - Fax:919-461-0114
Practice Address - Street 1:1010 HIGH HOUSE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-3576
Practice Address - Country:US
Practice Address - Phone:919-461-0110
Practice Address - Fax:919-461-0114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty