Organization
CAROLINA SURGICAL ARTS PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TODD GENE OWSLEY MD (PRESIDENT)
(336) 288-0677
Entity
Organization
Contact information
Practice address
2516 OAKCREST AVE, SUITE B, GREENSBORO, NC 27408-1932
(336) 288-0677
(336) 288-0784
Mailing address
2516 OAKCREST AVE, SUITE B, GREENSBORO, NC 27408-1932
(336) 288-0677
(336) 288-0784
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
34801
NC
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
34801
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0180T
BLUE CROSS BLUE SHIELD
NC
01
—
59-13002
NC MEDICAID DENTAL
NC
05
—
89-0180T
—
NC
Enumeration date
03/08/2007
Last updated
01/26/2010
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