Individual
HENRY MATTHEWS KIDD JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
613 GLEN EDEN DR, RALEIGH, NC 27612-5002
(919) 624-1186
Mailing address
613 GLEN EDEN DR, RALEIGH, NC 27612-5002
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
NC
Other
Enumeration date
06/24/2020
Last updated
01/21/2021
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