NPIMap

Organization Active NPI

Forsyth County Public Health Cleveland Ave Dental Center

  • Dentist
  • Winston Salem, NC
National Provider Identifier
1053868869
Registry record updated Sep 9, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
10063 Issued in NC
Legal business name
FORSYTH COUNTY PUBLIC HEALTH CLEVELAND AVE DENTAL CENTER
Practice address
501 N Cleveland Ave
Winston Salem, NC 27101-4366
Phone
(336) 703-3090
Fax
(336) 631-2340
NPI assigned
Sep 9, 2016
Last updated
Sep 9, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 9, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Sun Min Lee, DDSNPI 1851771513
Title
Dentist
Phone
(336) 703-3090

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 10063 NC Primary

Addresses

Primary practice location

501 N Cleveland Ave
Winston Salem, NC 27101-4366

Mailing address

501 N Cleveland Ave
Winston Salem, NC 27101-4366
Phone (336) 703-3090

Other identifiers 1

IdentifierTypeStateIssuer
1851771513MedicaidNC

National Provider Directory

National Provider Directory
Tax ID family
Forsyth County NC7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1473379200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1473379200000",
    "number": "1053868869",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 N CLEVELAND AVE",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271014366",
            "telephone_number": "336-703-3090",
            "fax_number": "336-631-2340"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 N CLEVELAND AVE",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271014366",
            "telephone_number": "336-703-3090",
            "fax_number": "336-631-2340"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORSYTH COUNTY PUBLIC HEALTH CLEVELAND AVE DENTAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-09",
        "last_updated": "2016-09-09",
        "status": "A",
        "authorized_official_last_name": "LEE",
        "authorized_official_first_name": "SUN MIN",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "336-703-3090",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NC",
            "license": "10063",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1851771513",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Winston Salem, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.