Provider Demographics
NPI:1215350533
Name:LANDMARK DENTISTRY BIRKDALE
Entity type:Organization
Organization Name:LANDMARK DENTISTRY BIRKDALE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:TRIPP
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:704-997-8280
Mailing Address - Street 1:8712 LINDHOLM DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-1870
Mailing Address - Country:US
Mailing Address - Phone:704-997-8280
Mailing Address - Fax:704-997-8274
Practice Address - Street 1:8712 LINDHOLM DR
Practice Address - Street 2:SUITE 200
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-1870
Practice Address - Country:US
Practice Address - Phone:704-997-8280
Practice Address - Fax:704-997-8274
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LANDMARK DENTISTRY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-01-22
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty