# IDLEWILD FAMILY DENTISTRY, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Idlewild Family Dentistry
- **Organization subpart:** No

## Provider details

- **NPI number:** 1649783119
- **Authorized official:** DR. MITESH DHULAB DMD (OWNER)
- **Authorized official phone:** (704) 893-0351

## Contact information

- **Practice address:** 4801 INDIAN TRAIL FAIRVIEW RD, INDIAN TRAIL, NC 28079-8865
- **Practice address phone:** (704) 893-0351
- **Practice address fax:** (704) 893-0354
- **Mailing address:** 4801 INDIAN TRAIL FAIRVIEW RD, INDIAN TRAIL, NC 28079-8865
- **Mailing address phone:** (704) 893-0351
- **Mailing address fax:** (704) 893-0354

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | NULL | Yes |
| 1223G0001X | General Practice Dentistry | — | — | Yes |
| 261QS1200X | Sleep Disorder Diagnostic Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 11/07/2017
- **Last updated:** 11/07/2017