Organization
CAROLINAS MOBILE DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DANIEL L WIENS (SENIOR VICE PRESIDENT)
(704) 355-0648
Entity
Organization
Contact information
Practice address
1000 BLYTHE BLVD, MEDICAL EDUCATION BUILDING, 2ND FLOOR, CHARLOTTE, NC 28203-5812
(704) 355-5317
(704) 355-0714
Mailing address
PO BOX 36154, CHARLOTTE, NC 28236-6154
(704) 355-5317
(704) 355-0714
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8902731
—
NC
Enumeration date
08/13/2006
Last updated
01/28/2008
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