Philip K Brantly, DDS
Individual provider Active NPI General Practice Dentistry · Goldsboro, NC
NPI 1114112703 · NPPES record last updated Sep 7, 2007
Key facts
- NPI
- 1114112703
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 4613 (NC)
- Practice address
- 1100 Parkway Dr
Suite a
Goldsboro, NC 27534-3477 - Phone
- (919) 751-0711
- Fax
- (919) 751-1248
- NPI assigned
- Sep 7, 2007
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| I20160607002023 | NC | Order and Referring Only - Dentist |
5496045296 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 4613 | NC | Yes |
Addresses
Primary practice location
1100 Parkway Dr
Suite a
Goldsboro, NC 27534-3477
Mailing address
1100 Parkway Dr
Suite a
Goldsboro, NC 27534-3477
Phone (919) 751-0711
Other providers in Goldsboro, NC
- Heather B Bradshaw
- Martha Ray Bradshaw
- Bharat Mahendra Brahmbhatt
- Pamela Dawn Branson
- Amy G. E. Brantley
- Breath of Life, Inc.
- Anissa Sheree Breland
- Brenda a. Taylor
- Bradley C Brenton
- Hannah Elisabeth Brewer
All providers in Goldsboro, NC · General Practice Dentistry in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 7, 2007. 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.