Organization
DRS SALLING AND TATE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. AMY L RUSSELL (OFFICE MANAGER)
(910) 256-9040
Entity
Organization
Contact information
Practice address
2002 EASTWOOD RD, STE 105, WILMINGTON, NC 28403
(910) 256-9040
(910) 256-2463
Mailing address
2002 EASTWOOD RD, STE 105, WILMINGTON, NC 28403
(910) 256-9040
(910) 256-2463
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
27865
UNITED CONCORDIA
—
01
—
646240
UNITED CONCORDIA
—
01
—
9016H
BCBS
NC
01
—
97551
BCBS
NC
Enumeration date
09/12/2006
Last updated
08/22/2020
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