Organization
COLLINS & SAMPSON DDS PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LEA B HUNT (INSURANE COORDNATOR)
(910) 521-8646
Entity
Organization
Contact information
Practice address
312 E. WARDELL RD, PEMBROKE, NC 28372-9262
(910) 521-8646
(910) 521-8643
Mailing address
312 E. WARDELL RD, PO BOX 2049, PEMBROKE, NC 28372-9262
(910) 521-8646
(910) 521-8643
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
0836
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
890116X
—
NC
05
—
8991735
—
NC
Enumeration date
06/21/2006
Last updated
06/15/2020
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