Organization
WALLACE CARRILLO-MEDINA DMD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WALLACE CARRILLO-MEDINA DMD PA (PRESIDENT)
(336) 629-3112
Entity
Organization
Contact information
Practice address
511 GREENSBORO ST, ASHEBORO, NC 27203-4736
(732) 692-6929
Mailing address
511 GREENSBORO ST, ASHEBORO, NC 27203-4736
(336) 629-3112
Taxonomy
Speciality
Code
Description
License number
State
1223X2210X
Orofacial Pain Dentistry
—
—
261QD0000X
Dental Clinic/Center
Primary
9900
NC
Other
Enumeration date
01/30/2018
Last updated
02/24/2021
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