Provider Demographics
NPI:1043669583
Name:CAROLINAS DENTIST ORAL SURGERY
Entity type:Organization
Organization Name:CAROLINAS DENTIST ORAL SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MISS
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:CREWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-951-9153
Mailing Address - Street 1:2301 ROBESON ST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28305-5640
Mailing Address - Country:US
Mailing Address - Phone:330-951-9153
Mailing Address - Fax:
Practice Address - Street 1:620 LILLINGTON HWY
Practice Address - Street 2:
Practice Address - City:SPRING LAKE
Practice Address - State:NC
Practice Address - Zip Code:28390-2269
Practice Address - Country:US
Practice Address - Phone:330-951-9153
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-06
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC97001223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty