Provider Demographics
NPI:1134391196
Name:SCOTT MENAKER DDS & PATRICIA RODNEY, DDS, PLLC
Entity type:Organization
Organization Name:SCOTT MENAKER DDS & PATRICIA RODNEY, DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:A
Authorized Official - Last Name:MENAKER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:704-377-2503
Mailing Address - Street 1:2711 RANDOLPH RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28207-2034
Mailing Address - Country:US
Mailing Address - Phone:704-377-2503
Mailing Address - Fax:704-377-6032
Practice Address - Street 1:2711 RANDOLPH RD
Practice Address - Street 2:SUITE 205
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-2034
Practice Address - Country:US
Practice Address - Phone:704-377-2503
Practice Address - Fax:704-377-6032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-31
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8283122300000X
NC5451122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1811070527OtherNPI DR.PATRICIA RODNEY
NC1972531648OtherDR SCOTT MENAKER DDS