Organization
BELLA DERMA SPA
Active
Other names
Bella Derma Spa
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DEMETRIA A CLARKSON OWNER (OWNER, LICENSED ESTHETICIAN)
(919) 862-4459
Entity
Organization
Contact information
Practice address
3211 ROGERS RD, SUITE 101, WAKE FOREST, NC 27587-3890
(919) 862-4459
Mailing address
3211 ROGERS RD, SUITE 101, WAKE FOREST, NC 27587-3890
(919) 862-4459
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
E5619
NC
Other
Enumeration date
05/01/2013
Last updated
05/01/2013
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