National Provider Identifier Database

IREDELL ORAL FACIAL SURGERY PC
Oral and Maxillofacial Surgery

The specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region.


Contact Information

IREDELL ORAL & FACIAL SURGERY PC
229 MEDICAL PARK RD
SUITE 310
MOORESVILLE, NC28117-8543
Phone: 704-799-0771
Fax: 704-799-2941
Website:
Specialty Taxonomy Code
* Oral and Maxillofacial Surgery 261QS0112X

* Indicates primary specialty

NPI Profile & details for IREDELL ORAL & FACIAL SURGERY PC

NPI Number 1639353659
Legal business name
LBN
IREDELL ORAL & FACIAL SURGERY PC
Authorized official KELLY MCCARTER - (OFFICE MANAGER)
Entity Organization
Organization subpart No
Enumeration date 12/27/2007
Last updated 08/29/2014 - About 12 years ago
Sole proprietor1 Not specified
Identifiers
  • NC License #: 9900556
  • NC Medicaid: 891218U
  • NC Other: 1218U BLUE CROSS BLUE SHIELD

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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