Individual
TASHANA DETWILER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
280 CONCORD PKWY S STE 110A, CONCORD, NC 28027-2704
(704) 920-1070
(704) 920-1071
Mailing address
5008 SHADOW PINE DR, CHARLOTTE, NC 28269-5142
(704) 780-3714
Taxonomy
Speciality
Code
Description
License number
State
1223D0001X
Public Health Dentistry
Primary
12420
NC
Other
Enumeration date
08/04/2021
Last updated
08/04/2021
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