Organization
CAROLINA PEDIATRIC DENTAL MANAGEMENT, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMENA HOLLEY (CREDENTIALING SPECIALIST)
(248) 550-5440
Entity
Organization
Contact information
Practice address
3000 NEW BERN AVE, RALEIGH, NC 27610-1231
(919) 570-0180
Mailing address
13580 GROUPE DR STE 305, WOODBRIDGE, VA 22192-4165
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Enumeration date
12/20/2023
Last updated
12/20/2023
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