NPIMap

Organization Active NPI

Macon, Collie, Pretzer, Kornstein and Hicks DDS

  • Pediatric Dentistry
  • Raleigh, NC
National Provider Identifier
1306894597
Registry record updated Oct 5, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
2934 Issued in NC
Legal business name
MACON, COLLIE, PRETZER, KORNSTEIN AND HICKS DDS
Practice address
7401 Creedmoor Rd
Raleigh, NC 27613-1640
Phone
(919) 848-3588
Fax
(919) 846-3550
NPI assigned
May 4, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 5, 2023

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

Authorized official

Name
Linda Tarantino
Title
Practice Manager
Phone
(919) 719-1780

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0221X 2934 NC Primary

Addresses

Primary practice location

7401 Creedmoor Rd
Raleigh, NC 27613-1640

Mailing address

7401 Creedmoor Rd
Raleigh, NC 27613-1640
Phone (919) 848-3588

Other identifiers 5

IdentifierTypeStateIssuer
6367OtherNCROBERT A. MORAN JR. DDS
8578OtherNCTRAVIS M. HICKS, DDS
90106OtherNCSTEPHEN C. PRETZER - BCBS
12624OtherNCKATHRYN E. DUNDERVILL DDS
7712OtherNCDAVID J. KORNSTEIN, DDS

Other names 1

  • Wake Orthodontics & Pediatric Dentistry Doing business as

National Provider Directory

National Provider Directory

Locations

7401 Creedmoor Rd
Raleigh, NC 27613
Phone (919) 622-2035

7200 Stonehenge Dr
Ste 102
Raleigh, NC 27613
Phone (919) 848-1882

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1146700800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696464000000",
    "number": "1306894597",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7401 CREEDMOOR RD",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276131640",
            "telephone_number": "919-848-3588",
            "fax_number": "919-846-3550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7401 CREEDMOOR RD",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276131640",
            "telephone_number": "919-848-3588",
            "fax_number": "919-846-3550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MACON, COLLIE, PRETZER, KORNSTEIN AND HICKS DDS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-04",
        "last_updated": "2023-10-05",
        "certification_date": "2023-09-26",
        "status": "A",
        "authorized_official_last_name": "TARANTINO",
        "authorized_official_first_name": "LINDA",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "919-719-1780"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NC",
            "license": "2934",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ROBERT A. MORAN JR. DDS",
            "identifier": "6367",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRAVIS M. HICKS, DDS",
            "identifier": "8578",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STEPHEN C. PRETZER - BCBS",
            "identifier": "90106",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KATHRYN E. DUNDERVILL DDS",
            "identifier": "12624",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DAVID J. KORNSTEIN, DDS",
            "identifier": "7712",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wake Orthodontics & Pediatric Dentistry",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Wake Orthodontics & Pediatric Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Raleigh, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2023; 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.