Organization
IDLEWILD FAMILY DENTISTRY, LLC
Active
Other names
Idlewild Family Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MITESH DHULAB DMD (OWNER)
(704) 893-0351
Entity
Organization
Contact information
Practice address
4801 INDIAN TRAIL FAIRVIEW RD, INDIAN TRAIL, NC 28079-8865
(704) 893-0351
(704) 893-0354
Mailing address
4801 INDIAN TRAIL FAIRVIEW RD, INDIAN TRAIL, NC 28079-8865
(704) 893-0351
(704) 893-0354
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
261QS1200X
Sleep Disorder Diagnostic Clinic/Center
—
—
Other
Enumeration date
11/07/2017
Last updated
11/07/2017
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