Organization
R KELLY FAULK JR DDS PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RANDOLPH KELLY FAULK JR. DDS (OWNER)
(919) 774-9419
Entity
Organization
Contact information
Practice address
1806 DOCTORS DR, SANFORD, NC 27330
(919) 774-9419
(919) 774-1404
Mailing address
1806 DOCTORS DR, SANFORD, NC 27330
(919) 774-9419
(919) 774-1404
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
6030
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8992816
BCBS
NC
05
—
8992816
—
NC
Enumeration date
12/27/2005
Last updated
08/22/2020
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