NPIMap

Organization Active NPI

Skip Tyson DDS & Stephanie Heaney DDS PA

  • Pediatric Dentistry
  • Wilmington, NC
National Provider Identifier
1083886345
Registry record updated Mar 27, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
6504 Issued in NC
Legal business name
SKIP TYSON DDS & STEPHANIE HEANEY DDS PA
Practice address
2606 Iron Gate Dr
Suite 200
Wilmington, NC 28412-2573
Phone
(910) 791-7380
NPI assigned
Mar 27, 2008
Last updated
Mar 27, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 27, 2008

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

Authorized official

Name
Stephanie Heaney, DDSNPI 1467516997
Title
Owner
Phone
(910) 791-7380

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Dentistry 1223P0221X 7278 NC
Pediatric Dentistry 1223P0221X 6504 NC Primary

Addresses

Primary practice location

2606 Iron Gate Dr
Suite 200
Wilmington, NC 28412-2573

Mailing address

2606 Iron Gate Dr
Suite 200
Wilmington, NC 28412-2573
Phone (910) 791-7380

Other identifiers 2

IdentifierTypeStateIssuer
89903CMedicaidNC
9003COtherNCBCBS

National Provider Directory

National Provider Directory

Locations

2606 Iron Gate Dr
Ste 200
Wilmington, NC 28412
Phone (910) 791-7380

Practitioners & affiliated clinicians

Practitioners 3

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": "1206576000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1206576000000",
    "number": "1083886345",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2606 IRON GATE DR",
            "address_2": "SUITE 200",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284122573",
            "telephone_number": "910-791-7380"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2606 IRON GATE DR",
            "address_2": "SUITE 200",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284122573",
            "telephone_number": "910-791-7380"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SKIP TYSON DDS & STEPHANIE HEANEY DDS PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-27",
        "last_updated": "2008-03-27",
        "status": "A",
        "authorized_official_last_name": "HEANEY",
        "authorized_official_first_name": "STEPHANIE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "910-791-7380",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NC",
            "license": "7278",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NC",
            "license": "6504",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89903C",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "9003C",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilmington, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2008; 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.