Provider profile · NPI 1659011914
Advanced Facial Surgery
Dentist, Oral and Maxillofacial Surgery · Harrisburg, NC · NPI 1659011914 · No federal exclusion match
✔ Verified against the public CMS NPPES registry & HHS-OIG LEIE as of Jun 21, 2026. Source-linked, daily-refreshed. Public data only — no PHI.
Registry details
Type
Organization
Primary specialty
Dentist, Oral and Maxillofacial Surgery
Enumerated
Apr 1, 2022
License(s)
—
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 5427 NC 49 S SUITE 104 | Harrisburg, NC 28075 | 704-839-0535 |
| MAILING | 301 INDIAN TRAIL RD S | Indian Trail, NC 28079 | 704-839-0535 |
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