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Organization
PURPLE TOOTH DENTAL
Active
Organization
PURPLE TOOTH DENTAL
Active
Other names
Jonathan Rainier Kaczmarski DMD, PLLC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANDY MANCINI (CEO)
(704) 885-2266
Entity
Organization
Contact information
Practice address
112 WOODLAWN AVE, MT HOLLY, NC 28120-1775
(704) 885-2266
Mailing address
112 WOODLAWN AVE, MT HOLLY, NC 28120-1775
(704) 885-2266
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1982835831
—
NC
Enumeration date
11/03/2021
Last updated
11/06/2021
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