Active NPI
R Kelly Faulk Jr DDS PA
- Dental Clinic/Center
- Sanford, NC
National Provider Identifier
1235116724
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Clinic/Center
- License
- 6030
- Legal business name
- R KELLY FAULK JR DDS PA
- Practice address
- 1806 Doctors Dr
Sanford, NC 27330 - Phone
- (919) 774-9419
- Fax
- (919) 774-1404
- NPI assigned
- Dec 27, 2005
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Randolph Kelly Faulk Jr., DDS
- Title
- Owner
- Phone
- (919) 774-9419
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) | Code | License | State | Primary |
|---|---|---|---|---|
| Dental Clinic/Center | 261QD0000X | 6030 | NC | Primary |
Addresses
Primary practice location
1806 Doctors Dr
Sanford, NC 27330
Mailing address
1806 Doctors Dr
Sanford, NC 27330
Phone (919) 774-9419
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8992816 | Medicaid | NC | |
| 8992816 | Other | NC | BCBS |
National Provider Directory
National Provider DirectoryLocations
1806 Doctors Dr
Sanford, NC 27330
Phone (919) 774-9419
Practitioners & affiliated clinicians
Practitioners 1
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.
-
- Dentist
- Sanford, NC
- NPI 1407807605
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1135641600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1598054400000",
"number": "1235116724",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1806 DOCTORS DR",
"city": "SANFORD",
"state": "NC",
"postal_code": "27330",
"telephone_number": "919-774-9419",
"fax_number": "919-774-1404"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1806 DOCTORS DR",
"city": "SANFORD",
"state": "NC",
"postal_code": "27330",
"telephone_number": "919-774-9419",
"fax_number": "919-774-1404"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "R KELLY FAULK JR DDS PA",
"organizational_subpart": "NO",
"enumeration_date": "2005-12-27",
"last_updated": "2020-08-22",
"status": "A",
"authorized_official_last_name": "FAULK",
"authorized_official_first_name": "RANDOLPH",
"authorized_official_middle_name": "KELLY",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "919-774-9419",
"authorized_official_name_prefix": "Dr.",
"authorized_official_name_suffix": "Jr.",
"authorized_official_credential": "DDS"
},
"taxonomies": [
{
"code": "261QD0000X",
"taxonomy_group": "",
"desc": "Clinic/Center, Dental",
"state": "NC",
"license": "6030",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8992816",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "8992816",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Sanford, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.