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Organization
SAMUEL G. KOONCE, JR., DDS, PA
Active
Organization
SAMUEL G. KOONCE, JR., DDS, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SAMUEL GRADY KOONCE JR. DDS (PRESIDENT)
(910) 642-4529
Entity
Organization
Contact information
Practice address
900 SPIVEY RD, WHITEVILLE, NC 28472-2915
(910) 642-4529
Mailing address
900 SPIVEY RD, PO BOX 965, WHITEVILLE, NC 28472-2915
(910) 642-4529
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
4365
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8995053
—
NC
Enumeration date
02/18/2008
Last updated
02/18/2008
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