Provider Demographics
NPI:1306894597
Name:MACON, COLLIE, PRETZER, KORNSTEIN AND HICKS DDS
Entity type:Organization
Organization Name:MACON, COLLIE, PRETZER, KORNSTEIN AND HICKS DDS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:TARANTINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-719-1780
Mailing Address - Street 1:7401 CREEDMOOR RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613-1640
Mailing Address - Country:US
Mailing Address - Phone:919-848-3588
Mailing Address - Fax:919-846-3550
Practice Address - Street 1:7401 CREEDMOOR RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27613-1640
Practice Address - Country:US
Practice Address - Phone:919-848-3588
Practice Address - Fax:919-846-3550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC29341223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6367OtherROBERT A. MORAN JR. DDS
NC8578OtherTRAVIS M. HICKS, DDS
NC90106OtherSTEPHEN C. PRETZER - BCBS
NC12624OtherKATHRYN E. DUNDERVILL DDS
NC7712OtherDAVID J. KORNSTEIN, DDS
NC8994149Medicare ID - Type UnspecifiedBURTON A. HORWITZ
NC94149OtherBURTON A. HORWITZ - BCBS
NC90106OtherSTEPHEN C. PRETZER - BCBS
NC8990106Medicare ID - Type UnspecifiedSTEPHEN C. PRETZER