Tina Joell-Kennedy Parker, DDS
Individual provider Active NPI Dentist · Wallace, NC
NPI 1013105782 · NPPES record last updated Jun 11, 2020
Key facts
- NPI
- 1013105782
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 8553 (NC)
- Practice address
- 522 S Norwood St
Wallace, NC 28466-1620 - Phone
- (910) 285-7800
- NPI assigned
- Oct 9, 2007
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NC
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160822000080 | NC | Order and Referring Only - Oral Surgery |
3678619152 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8553 | NC | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| A Darren Sholar, DDS,PA | Current | Accepting new patients |
Locations
522 S Norwood St
Wallace, NC 28466
Phone (910) 285-7800
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 8553 | NC | Yes |
Addresses
Primary practice location
522 S Norwood St
Wallace, NC 28466-1620
Mailing address
522 S Norwood St
P O Box 875
Wallace, NC 28466-1620
Phone (910) 285-7800
Other providers in Wallace, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 11, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.