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Organization
PAUL D. NIFONG JR. DDSPA
Active
Organization
PAUL D. NIFONG JR. DDSPA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PAUL DOUGLAS NIFONG JR. DDS (PRESIDENT)
(336) 766-6457
Entity
Organization
Contact information
Practice address
3624 CLEMMONS ROAD, CLEMMONS, NC 27012-0325
(336) 766-6457
Mailing address
PO BOX 325, CLEMMONS, NC 27012-0325
(336) 766-6457
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
4520
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8996451
—
NC
Enumeration date
08/10/2006
Last updated
08/22/2020
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