Organization
IREDELL ORAL & FACIAL SURGERY PC
Active
Other names
Johnson Oral Surgery
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KELLY MCCARTER (OFFICE MANAGER)
(704) 799-0771
Entity
Organization
Contact information
Practice address
229 MEDICAL PARK RD, SUITE 310, MOORESVILLE, NC 28117-8543
(704) 799-0771
(704) 799-2941
Mailing address
229 MEDICAL PARK RD, SUITE 310, MOORESVILLE, NC 28117-8543
(704) 799-0771
(704) 799-2941
Taxonomy
Speciality
Code
Description
License number
State
261QS0112X
Oral and Maxillofacial Surgery Clinic/Center
Primary
9900556
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1218U
BLUE CROSS BLUE SHIELD
NC
05
—
891218U
—
NC
Enumeration date
12/27/2007
Last updated
08/29/2014
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