Organization
WALLACE CARRILLO-MEDINA DMD MS PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WALLACE C CARRILLO-MEDINA DMD (PRESIDENT)
(336) 629-3112
Entity
Organization
Contact information
Practice address
511 GREENSBORO ST, ASHEBORO, NC 27203-4736
(336) 629-3112
(336) 629-4251
Mailing address
511 GREENSBORO ST, ASHEBORO, NC 27203-4736
(336) 629-3112
(336) 629-4251
Taxonomy
Speciality
Code
Description
License number
State
1223X2210X
Orofacial Pain Dentistry
Primary
—
—
Other
Enumeration date
06/19/2020
Last updated
06/19/2020
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