Organization
MECKLENBURG COUNTY
Active
Other names
Mecklenburg County Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
EARL WINTERS MABRY MD (HEALTH DIRECTOR)
(704) 336-2299
Entity
Organization
Contact information
Practice address
1801 ROZZELLES FERRY RD, CHARLOTTE, NC 28208-4228
(704) 350-7305
(704) 350-7304
Mailing address
1801 ROZZELLES FERRY RD, CHARLOTTE, NC 28208-4228
(704) 350-7305
(704) 350-7304
Taxonomy
Speciality
Code
Description
License number
State
1223D0001X
Public Health Dentistry
Primary
—
—
261QD0000X
Dental Clinic/Center
—
—
261QP0905X
State or Local Public Health Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
015N0
NC HEALTH CHOICE GROUP #
NC
05
—
89015N0
—
NC
Enumeration date
07/15/2006
Last updated
12/13/2012
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