Organization
ORAL & MAXILLOFACIAL SURGERY ASSOCIATES PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BECKY COLEY (ADMINISTRATIVE SUPERVISOR)
(919) 479-0707
Entity
Organization
Contact information
Practice address
2823 N DUKE ST, DURHAM, NC 27704-2621
(919) 479-0707
(919) 479-5435
Mailing address
2823 N DUKE ST, DURHAM, NC 27704-2621
(919) 479-0707
(919) 479-5435
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
3213
NC
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
4344
NC
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
4783
NC
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
5471
NC
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
9600058
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02006
BCBS GROUP ID
NC
05
—
8902006
—
NC
Enumeration date
07/12/2005
Last updated
02/06/2018
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