Provider Demographics
NPI:1245470285
Name:CAROLINAS CENTER FOR ORAL HEALTH
Entity type:Organization
Organization Name:CAROLINAS CENTER FOR ORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:VANDERBAAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-512-2117
Mailing Address - Street 1:1601 ABBEY PL
Mailing Address - Street 2:SUITE 220
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28209-3835
Mailing Address - Country:US
Mailing Address - Phone:704-512-2110
Mailing Address - Fax:704-512-2115
Practice Address - Street 1:1601 ABBEY PL
Practice Address - Street 2:SUITE 220
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28209-3835
Practice Address - Country:US
Practice Address - Phone:704-512-2110
Practice Address - Fax:704-512-2115
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAROLINAS HEALTHCARE SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-03-04
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental