Provider Demographics
NPI:1154564763
Name:PARADISE FAMILY DENTISTRY
Entity type:Organization
Organization Name:PARADISE FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVE
Authorized Official - Middle Name:ERSKINE
Authorized Official - Last Name:FOULKES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:336-272-8087
Mailing Address - Street 1:104 W NORTHWOOD ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-1326
Mailing Address - Country:US
Mailing Address - Phone:336-272-8087
Mailing Address - Fax:336-272-8098
Practice Address - Street 1:104 W NORTHWOOD ST
Practice Address - Street 2:SUITE C
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1326
Practice Address - Country:US
Practice Address - Phone:336-272-8087
Practice Address - Fax:336-272-8098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-13
Last Update Date:2009-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7603302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization