Organization
BLUEWAVE DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KELLY DAVIS (PRACTICE MANAGER)
(910) 383-2615
Entity
Organization
Contact information
Practice address
1300 S DICKINSON DR, LELAND, NC 28451-6430
(910) 383-2615
(910) 383-2618
Mailing address
1300 S DICKINSON DR, LELAND, NC 28451-6430
(910) 383-2615
(910) 383-2618
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
8379
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7812
NC STATE BOARD OF DENTAL EXAMINERS
NC
01
—
8379
NC SATE BOARD OF DENTAL EXAMINERS
NC
Enumeration date
05/09/2018
Last updated
05/09/2018
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