Organization
SAMUEL G. KOONCE, JR., DDS, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SAMUEL GRADY KOONCE JR. DDS (PRESIDENT)
(910) 642-4529
Entity
Organization
Contact information
Practice address
900 SPIVEY RD, WHITEVILLE, NC 28472-2915
(910) 642-4529
Mailing address
900 SPIVEY RD, PO BOX 965, WHITEVILLE, NC 28472-2915
(910) 642-4529
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
4365
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8995053
—
NC
Enumeration date
02/18/2008
Last updated
02/18/2008
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