Provider Demographics
NPI:1932634029
Name:SURGICAL CENTER FOR DENTAL PROFESSIONALS OF NC LLC
Entity Type:Organization
Organization Name:SURGICAL CENTER FOR DENTAL PROFESSIONALS OF NC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:UDAY
Authorized Official - Middle Name:N
Authorized Official - Last Name:REEBYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-932-4425
Mailing Address - Street 1:9650 STRICKLAND RD
Mailing Address - Street 2:SUITE 103-177
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-1902
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2620 NEW BERN AVE
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-1821
Practice Address - Country:US
Practice Address - Phone:919-225-6899
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-26
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC812162341261QA1903X
NC=========261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical