Individual
CHARLES RANDALL MACON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
7200 STONEHENGE DR, SUITE 102, RALEIGH, NC 27613-1620
(919) 848-1882
Mailing address
7200 STONEHENGE DR, SUITE 102, RALEIGH, NC 27613-1620
(919) 848-1882
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
6058
NC
Other
Enumeration date
07/26/2006
Last updated
07/08/2007
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