# GREATER CHARLOTTE ORAL & FACIAL SURGERY

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Greater Charlotte Oral & Facial Surgery
- **Organization subpart:** No

## Provider details

- **NPI number:** 1124595475
- **Authorized official:** JENNIFER HALL (BILLING SUPERVISOR)
- **Authorized official phone:** (704) 542-9600

## Contact information

- **Practice address:** 527 S NEW HOPE RD, GASTONIA, NC 28054-4040
- **Practice address phone:** (704) 542-9600
- **Practice address fax:** (704) 215-6904
- **Mailing address:** 10042 PARK CEDAR DR STE B, CHARLOTTE, NC 28210-8917
- **Mailing address phone:** (704) 542-9600
- **Mailing address fax:** (704) 542-9651

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | NULL | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | Yes |

## Other

- **Enumeration date:** 10/25/2018
- **Last updated:** 10/25/2018