Organization
PURPLE TOOTH DENTAL
Active
Other names
Jonathan Rainier Kaczmarski DMD, PLLC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANDY MANCINI (CEO)
(704) 885-2266
Entity
Organization
Contact information
Practice address
112 WOODLAWN AVE, MT HOLLY, NC 28120-1775
(704) 885-2266
Mailing address
112 WOODLAWN AVE, MT HOLLY, NC 28120-1775
(704) 885-2266
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1982835831
—
NC
Enumeration date
11/03/2021
Last updated
11/06/2021
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