Provider Demographics
NPI:1144651605
Name:SCHEETZ AND BACHARA FAMILY DENTISTRY
Entity type:Organization
Organization Name:SCHEETZ AND BACHARA FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/ BUSINESS OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KURT
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:SCHEETZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-457-5061
Mailing Address - Street 1:1301 N HOWE ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHPORT
Mailing Address - State:NC
Mailing Address - Zip Code:28461-2604
Mailing Address - Country:US
Mailing Address - Phone:910-457-5061
Mailing Address - Fax:
Practice Address - Street 1:1301 N HOWE ST
Practice Address - Street 2:
Practice Address - City:SOUTHPORT
Practice Address - State:NC
Practice Address - Zip Code:28461-2604
Practice Address - Country:US
Practice Address - Phone:910-457-5061
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-10
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8925122300000X
NC5788122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty