Individual
DR. DALE A CHILDERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
2409 ROBESON STREET, FAYETTEVILLE, NC 28305
(910) 483-9546
(910) 483-8550
Mailing address
2409 ROBESON STREET, FAYETTEVILLE, NC 28305
(910) 483-9546
(910) 483-8550
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
4973
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
467383
INDIVIDUAL #-UNITED CONCO
NC
05
—
890138F
—
NC
05
—
8991553
—
NC
01
—
955715
GROUP #-UNITED CONCORDIA
NC
Enumeration date
10/02/2006
Last updated
07/09/2007
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