Provider Demographics
NPI:1841222072
Name:RHYNE, K. MICHAEL (DDSPA)
Entity type:Individual
Prefix:DR
First Name:K.
Middle Name:MICHAEL
Last Name:RHYNE
Suffix:
Gender:M
Credentials:DDSPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 SARDIS RD N
Mailing Address - Street 2:SUITE 105
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28227-7711
Mailing Address - Country:US
Mailing Address - Phone:704-847-7730
Mailing Address - Fax:704-844-9609
Practice Address - Street 1:2101 SARDIS RD N
Practice Address - Street 2:SUITE 105
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28227-7711
Practice Address - Country:US
Practice Address - Phone:704-847-7730
Practice Address - Fax:704-844-9609
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC43941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8997362Medicaid