Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | NC 4535 | NC |
NPI | 1053525592 |
---|---|
Provider Name | Mr. Macon Michell Singletary |
First Address | Raleigh, NC 27615 |
Second Address | Raleigh, NC 27615 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2007 |
Last Update Date | 08/07/2007 |