Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 9496 | NC |
NPI | 1003252917 |
---|---|
Provider Name | Dr. Kenly Lewis Dine |
First Address | Fayetteville, NC 28311-7672 |
Second Address | Fayetteville, NC 28311-7672 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2013 |
Last Update Date | 25/08/2020 |