Provider Demographics
NPI:1801917190
Name:MOHORN, BELCHER & GOLLEHON, DDS. PA
Entity type:Organization
Organization Name:MOHORN, BELCHER & GOLLEHON, DDS. PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:GROUP ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:BROOKSHIRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-273-1000
Mailing Address - Street 1:2105 BRAXTON LANE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408
Mailing Address - Country:US
Mailing Address - Phone:336-273-1000
Mailing Address - Fax:336-275-9919
Practice Address - Street 1:2105 BRAXTON LANE
Practice Address - Street 2:SUITE 102
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408
Practice Address - Country:US
Practice Address - Phone:336-273-1000
Practice Address - Fax:336-275-9919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8990160Medicaid
NC8998158Medicaid
NC8990074Medicaid
NC89902GJMedicaid
NCT63826Medicare UPIN
NCU72670Medicare UPIN
NC8990160Medicaid
NC2428832Medicare PIN
NC8990074Medicaid
NC2428694Medicare PIN
NC89902GJMedicaid
NC241108AMedicare PIN