Provider Demographics
NPI:1154350114
Name:SMALL, DAVID CHARLES (DDS, MS, PA)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:CHARLES
Last Name:SMALL
Suffix:
Gender:M
Credentials:DDS, MS, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 JUNIPER ST STE 300
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-4677
Mailing Address - Country:US
Mailing Address - Phone:828-433-1242
Mailing Address - Fax:828-437-3899
Practice Address - Street 1:110 JUNIPER ST STE 300
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-4677
Practice Address - Country:US
Practice Address - Phone:828-433-1242
Practice Address - Fax:828-437-3899
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC72321223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7232OtherDENTAL LICENSE
NC562229449OtherTAX ID #
NC899014CMedicaid
NC9014COtherBCBS PROVIDER #
NC9014COtherBCBS PROVIDER #