Provider Demographics
NPI:1053561555
Name:A DARREN SHOLAR, DDS,PA
Entity type:Organization
Organization Name:A DARREN SHOLAR, DDS,PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:AXON
Authorized Official - Middle Name:DARREN
Authorized Official - Last Name:SHOLAR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:910-285-7800
Mailing Address - Street 1:522 S NORWOOD ST
Mailing Address - Street 2:
Mailing Address - City:WALLACE
Mailing Address - State:NC
Mailing Address - Zip Code:28466-1620
Mailing Address - Country:US
Mailing Address - Phone:910-285-7800
Mailing Address - Fax:910-285-6097
Practice Address - Street 1:522 S NORWOOD ST
Practice Address - Street 2:
Practice Address - City:WALLACE
Practice Address - State:NC
Practice Address - Zip Code:28466-1620
Practice Address - Country:US
Practice Address - Phone:910-285-7800
Practice Address - Fax:910-285-6097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-22
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC62681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1680308OtherUNITED CONCORDIA
NC97800OtherBCBS
NC385397OtherTRIGON
NC8997800Medicaid