Individual
DR. KERVIN BRANDON MACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARM.D., D.M.D.
Contact information
Practice address
1628 MEMORIAL DR, #C, BURLINGTON, NC 27215-3592
(336) 227-5594
Mailing address
1628 MEMORIAL DR, #C, BURLINGTON, NC 27215-3592
(336) 227-5594
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
8824
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5918330
—
NC
Enumeration date
04/13/2011
Last updated
11/17/2012
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