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Provider Information for 1952893026

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know


Gender: MALE

Individual NPI: 1952893026

Calendar   Last Updated:  2020-01-07
  Certification Date:  2020-01-07


Name Value
NPI 1952893026
Enumeration Date 2018-06-04
NPI Type 1 - Individual
Sole Proprietor YES
Status Active
Mailing Address 3 E SHORE DR
ASHEVILLE, NC 28805-2201
United States

Phone: | Fax:
View Map External Link
Primary Practice Address 617 CEMETERY RD
WINLOCK, WA 98596-9303
United States

Phone: 360-785-4755 | Fax:
View Map External Link
Secondary Practice Address 55 MORGAN ST
MARION, NC 28752-4935
United States

Phone: 828-652-6967 | Fax:
View Map External Link

Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Primary Taxonomy Selected Taxonomy State License Number
Yes 122300000X - Dentist WA DE61007637
No 122300000X - Dentist NC 11032