Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 9406 | NC |
N | 204E00000X | Oral & Maxillofacial Surgeon | D-8950 | MA |
NPI | 1174650527 |
---|---|
Provider Name | Richard R. Rolle JR. |
First Address | Mooresville, NC 28117-8543 |
Second Address | Cornelius, NC 28031-8187 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2007 |
Last Update Date | 20/11/2012 |