Provider Demographics
NPI:1306806104
Name:CLINE, DOROTHY JACOBYANSKY
Entity type:Individual
Prefix:MS
First Name:DOROTHY
Middle Name:JACOBYANSKY
Last Name:CLINE
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:DOROTHY
Other - Middle Name:ANNE
Other - Last Name:JACOBYANSKY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:109 STOKES CT
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-4663
Mailing Address - Country:US
Mailing Address - Phone:910-487-3418
Mailing Address - Fax:
Practice Address - Street 1:109 STOKES CT
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-4663
Practice Address - Country:US
Practice Address - Phone:910-487-3418
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2014-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS020049L1223G0001X
NC74451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice