NPIMap

Organization Active NPI

Park Cedar Dentistry Partnership

Doing business as Park Cedar Dentistry

  • General Practice Dentistry
  • Charlotte, NC
National Provider Identifier
1063415032
Registry record updated Feb 10, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
7809 Issued in NC
Legal business name
PARK CEDAR DENTISTRY PARTNERSHIP
Doing business as
Park Cedar Dentistry
Practice address
10027 Park Cedar Dr
Ste 100
Charlotte, NC 28210-8903
Phone
(704) 752-0500
Fax
(704) 752-0502
NPI assigned
May 24, 2005
Last updated
Feb 10, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 10, 2015

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

Authorized official

Name
Dr. Summer L Caldwell, DDSNPI 1427494293
Title
Partner
Phone
(704) 752-0500

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X 9488 NC
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X 7809 NC Primary

Addresses

Primary practice location

10027 Park Cedar Dr
Ste 100
Charlotte, NC 28210-8903

Mailing address

10027 Park Cedar Dr
Ste 100
Charlotte, NC 28210-8903
Phone (704) 752-0500

Other identifiers 1

IdentifierTypeStateIssuer
98190OtherNCBLUE CROSS BLUE SHIELD

Other names 1

  • Park Cedar Dentistry Doing business as

National Provider Directory

National Provider Directory

Locations

10027 Park Cedar Dr
Ste 100
Charlotte, NC 28210
Phone (704) 752-0500

Practitioners & affiliated clinicians

Practitioners 4

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": "1116892800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1423526400000",
    "number": "1063415032",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10027 PARK CEDAR DR",
            "address_2": "STE 100",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282108903",
            "telephone_number": "704-752-0500",
            "fax_number": "704-752-0502"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10027 PARK CEDAR DR",
            "address_2": "STE 100",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282108903",
            "telephone_number": "704-752-0500",
            "fax_number": "704-752-0502"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARK CEDAR DENTISTRY PARTNERSHIP",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-05-24",
        "last_updated": "2015-02-10",
        "status": "A",
        "authorized_official_last_name": "CALDWELL",
        "authorized_official_first_name": "SUMMER",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "704-752-0500",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "NC",
            "license": "9488",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "NC",
            "license": "7809",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "98190",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Park Cedar Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Charlotte, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2015; 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.