Provider Demographics
NPI:1952492811
Name:MARCIA L REMENTER DMD PA II
Entity Type:Organization
Organization Name:MARCIA L REMENTER DMD PA II
Other - Org Name:CHATHAM DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO OWNER OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DENIS
Authorized Official - Middle Name:
Authorized Official - Last Name:RACZKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-477-3369
Mailing Address - Street 1:100 VILLAGE LAKE ROAD
Mailing Address - Street 2:
Mailing Address - City:SILER CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27344
Mailing Address - Country:US
Mailing Address - Phone:919-663-4000
Mailing Address - Fax:919-663-1957
Practice Address - Street 1:100 VILLAGE LAKE ROAD
Practice Address - Street 2:
Practice Address - City:SILER CITY
Practice Address - State:NC
Practice Address - Zip Code:27344
Practice Address - Country:US
Practice Address - Phone:919-663-4000
Practice Address - Fax:919-663-1957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC54561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5906440Medicaid