Organization
WATERSIDE DERMATOLOGY AND LASER CENTER PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEBRA DIANE POWELL PA-C (OWNER)
(704) 995-7941
Entity
Organization
Contact information
Practice address
7476 WATERSIDE LOOP RD, SUITE 600, DENVER, NC 28037-7679
(704) 601-4381
(704) 822-5997
Mailing address
7476 WATERSIDE LOOP RD, SUITE 600, DENVER, NC 28037-7679
(704) 601-4381
(704) 822-5997
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5912698
—
NC
Enumeration date
07/06/2009
Last updated
02/10/2010
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