Provider Demographics
NPI:1801115266
Name:DRS DEST GARDEN HENDRICK & KINGSBURY PLLC III
Entity type:Organization
Organization Name:DRS DEST GARDEN HENDRICK & KINGSBURY PLLC III
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:F
Authorized Official - Last Name:DEST
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:704-547-1279
Mailing Address - Street 1:8305 UNIVERSITY EXEC PARK DR STE 300
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-3357
Mailing Address - Country:US
Mailing Address - Phone:704-547-1279
Mailing Address - Fax:704-547-8383
Practice Address - Street 1:1639 US HIGHWAY 74A BYP
Practice Address - Street 2:
Practice Address - City:SPINDALE
Practice Address - State:NC
Practice Address - Zip Code:28160-1886
Practice Address - Country:US
Practice Address - Phone:704-547-1279
Practice Address - Fax:704-547-8383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-25
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty