| Lake Norman Dentistry | |
|
224 Talbert Rd Mooresville NC 28117-9124 | |
| (704) 799-0552 | |
| (704) 749-8653 |
| Full Name | Lake Norman Dentistry |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 224 Talbert Rd, Mooresville, North Carolina |
| Authorized Official Name and Position | Manisha D Patel (OWNER) |
| Authorized Official Contact | 7047990552 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lake Norman Dentistry 224 Talbert Rd Mooresville NC 28117-9124 Ph: (704) 799-0552 | Lake Norman Dentistry 224 Talbert Rd Mooresville NC 28117-9124 Ph: (704) 799-0552 |
| NPI Number | 1053550145 |
|---|---|
| Provider Enumeration Date | 02/12/2009 |
| Last Update Date | 02/12/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053550145 | NPI | - | NPPES |
| 899008C | Medicaid | NC | |
| 899008A | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 6771 (North Carolina) | Secondary |
| 1223G0001X | Dentist - General Practice | 6332 (North Carolina) | Primary |
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