Individual provider Active NPI

Frederick Bryan Tate, DDS

  • General Practice Dentistry
  • Wilmington, NC
National Provider Identifier
1295839769
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
6728 Issued in NC
Practice address
2002 Eastwood Rd
Ste 105
Wilmington, NC 28403
Phone
(910) 256-9040
Fax
(910) 256-2463
NPI assigned
Sep 12, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 6728 NC Primary

Addresses

Primary practice location

2002 Eastwood Rd
Ste 105
Wilmington, NC 28403

Mailing address

2002 Eastwood Rd
Ste 105
Wilmington, NC 28403
Phone (910) 256-9040

Other identifiers 3

IdentifierTypeStateIssuer
646240OtherUNITED CONCORDIA
9016HOtherNCBCBS
97551MedicaidNC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170629001424 NC Order and Referring Only - DentistPractitioner - Dentist 5991074288

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6728NCMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
DRS Salling and Tate General Practice Past Accepting new patients

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1158019200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1295839769",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2002 EASTWOOD RD",
            "address_2": "STE 105",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "28403",
            "telephone_number": "910-256-9040",
            "fax_number": "910-256-2463"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2002 EASTWOOD RD",
            "address_2": "STE 105",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "28403",
            "telephone_number": "910-256-9040",
            "fax_number": "910-256-2463"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TATE",
        "first_name": "FREDERICK",
        "middle_name": "BRYAN",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-12",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NC",
            "license": "6728",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "646240",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "9016H",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "97551",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilmington, NC

Sources for this page

Verify at the official NPI Registry.