Organization
PAUL D. NIFONG JR. DDSPA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PAUL DOUGLAS NIFONG JR. DDS (PRESIDENT)
(336) 766-6457
Entity
Organization
Contact information
Practice address
3624 CLEMMONS ROAD, CLEMMONS, NC 27012-0325
(336) 766-6457
Mailing address
PO BOX 325, CLEMMONS, NC 27012-0325
(336) 766-6457
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
4520
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8996451
—
NC
Enumeration date
08/10/2006
Last updated
08/22/2020
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