Active NPI
Tara Leigh Secret, DDS
- Dentist
- Charlotte, NC
National Provider Identifier
1356548184
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 3710
- Practice address
- 8220 University Executive Dr
Suite 111
Charlotte, NC 28262 - Phone
- (704) 548-8563
- Fax
- (704) 510-2793
- NPI assigned
- Jun 27, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 3710 | WV | Primary |
Addresses
Primary practice location
8220 University Executive Dr
Suite 111
Charlotte, NC 28262
Mailing address
741 Mulberry Ave
Clarksburg, WV 26301-2651
Phone (304) 669-8999
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WV
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150722003808 | WV | Order and Referring Only - Oral Surgery | 8628381449 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3710 | WV | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1182902400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1356548184",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "741 MULBERRY AVE",
"city": "CLARKSBURG",
"state": "WV",
"postal_code": "263012651",
"telephone_number": "304-669-8999"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8220 UNIVERSITY EXECUTIVE DR",
"address_2": "SUITE 111",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "28262",
"telephone_number": "704-548-8563",
"fax_number": "704-510-2793"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SECRET",
"first_name": "TARA",
"middle_name": "LEIGH",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-06-27",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "WV",
"license": "3710",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Charlotte, NC
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- Securing Resources for Consumers, Inc. (SRFC, Inc.)
- NA'Imah Fareedah Sedegah, PHD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.