Mack, Kervin Brandon

Mack, Kervin Brandon is an individual health care provider with primary practice located at 1628 Memorial Dr #C, Burlington NC 27215-3592. He recently has only one registered license in Dental Providers / Orthodontics and Dentofacial Orthopedics, which is considered as his primary health care specialty. Mack, Kervin Brandon can be contacted via phone (336) 227-5594.

Contact Information

Primary practice address
1628 Memorial Dr #C Burlington NC 27215-3592
Phone: (336) 227-5594
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Orthodontics and Dentofacial Orthopedics 1223X0400X 8824 North Carolina

Profile Details

NPI number 1316237290
LBN Legal business name Mack, Kervin Brandon
Credentials PHARM.D., D.M.D.
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 13th, 2011
Last updated Nov 17th, 2012 - about 14 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1316237290 NPPES
North Carolina MEDICAID 5918330

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