Provider Demographics
NPI:1194076976
Name:MORGANTON CHILDREN'S DENTAL CENTER
Entity type:Organization
Organization Name:MORGANTON CHILDREN'S DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CAMERON
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-433-5800
Mailing Address - Street 1:206 S STERLING ST
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-3567
Mailing Address - Country:US
Mailing Address - Phone:828-433-5800
Mailing Address - Fax:828-433-5811
Practice Address - Street 1:206 S STERLING ST
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-3567
Practice Address - Country:US
Practice Address - Phone:828-433-5800
Practice Address - Fax:828-433-5811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-20
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2000020850111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty