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Organization
WILKES DENTAL CONSORTIUM
Active
Organization
WILKES DENTAL CONSORTIUM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEDRA ROBERTS (FRONT DESK MANAGER)
(336) 903-9399
Entity
Organization
Contact information
Practice address
1915 W PARK DR STE 104, NORTH WILKESBORO, NC 28659-3777
(336) 903-9399
Mailing address
1915 W PARK DR STE 104, NORTH WILKESBORO, NC 28659-3777
(336) 903-9399
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1962565788
—
NC
01
—
911943799
NCHC
NC
Enumeration date
08/01/2017
Last updated
07/21/2022
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