Organization Name: | GLYNDA R. MCCONVILLE, DDS, PA |
NPI Number: | 1013164185 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | GLYNDA MCCONVILLE (OWNER/PRESIDENT) |
Mailing Address: | 1129 Carthage St Sanford |
State: | NC US |
Postal Code: | 273304162 |
Phone Number: | 9197189188 |
Fax Number: | 9197180900 |
NPI Enumeration Date: | 08/20/2008 |
NPI Last Update Date: | 08/20/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QD0000X |
License Number: | 7021 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NC |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Dental |
Taxonomy Definition: |