Justin Lewis Tomack, DMD

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

12463 Issued in NC

Practice address

1725 S Main St Ste 101
Wake Forest, NC 27587-5012

Phone

(919) 841-1720

NPI assigned

Jul 2, 2020

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jul 12, 2023 through Jul 12, 2027

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• K. Kevin Neshat, DDS, MD, PA

  dba Nu-Image Surgical Center

  • Oral and Maxillofacial Surgery Clinic/Center
  • Raleigh, NC
  • NPI 1770637779
  NPD (past)

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

{
    "created_epoch": "1593648000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1685836800000",
    "number": "1134746464",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1725 S MAIN ST STE 101",
            "city": "WAKE FOREST",
            "state": "NC",
            "postal_code": "275875012",
            "telephone_number": "919-841-1720"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1725 S MAIN ST STE 101",
            "city": "WAKE FOREST",
            "state": "NC",
            "postal_code": "275875012",
            "telephone_number": "919-841-1720"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TOMACK",
        "first_name": "JUSTIN",
        "middle_name": "LEWIS",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-07-02",
        "last_updated": "2023-06-04",
        "certification_date": "2023-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MA",
            "license": "DN1858766",
            "primary": false
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "NC",
            "license": "12463",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Thrive Transport
• Shawna L Thrower, FNP-BC
• Sophia Tran Hoai Huong Tieu, PA-C
• Jovhannah Tisdale, LMBT
• Vonda Kay Tobey-Dennis, CNA
• Olivia Tomasiello, DPT
• Kimberly S. Tomlin, RPH
• Everlyan Torres, FNP-BC
• Therese Torres, MS, CCC-SLP
• Deborah M Townsend, RPH

• Periodontics in Wake Forest, NC
• Providers in Wake Forest, NC by specialty
• Periodontics in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.