NPIMap

Organization Active NPI

East Carolina University

Doing business as East Carolina University School of Dental Medicine, CSLC Brunswick

  • General Practice Dentistry
  • Bolivia, NC
National Provider Identifier
1427452283
Registry record updated Jul 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
EAST CAROLINA UNIVERSITY
Doing business as
East Carolina University School of Dental Medicine, CSLC Brunswick
Practice address
100 Brunswick Medical Center Pkwy NE
Bolivia, NC 28422-1001
Phone
(910) 253-9000
Fax
(910) 253-9033
NPI assigned
Oct 22, 2014
Last updated
Jul 26, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
EAST CAROLINA UNIVERSITYAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 26, 2024

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

Authorized official

Name
Dr. Dexter Gregory Chadwick, DDS, MS
Title
Dean, School of Dental Medicine
Phone
(252) 737-7000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X Primary

Addresses

Primary practice location

100 Brunswick Medical Center Pkwy NE
Bolivia, NC 28422-1001

Mailing address

100 Brunswick Medical Center Parkway
Bolivia, NC 28422
Phone (910) 253-9000

Other names 2

  • East Carolina University School of Dental Medicine, CSLC Brunswick Doing business as
  • ECU School of Dental Medicine Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031106000400 NC Part B Supplier - Clinic/Group Practice 0244143246 Receives reassigned benefits from 978 practitioners
13 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Greenville, NC; Lillington, NC; Lumberton, NC; Robersonville, NC; Spruce Pine, NC; Sylva, NC; Thomasville, NC; Washington, NC…

Other NPIs on the same Medicare enrollment 13

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 13

National Provider Directory

National Provider Directory
Tax ID family
Ecu School Medicine Cli64 organizations share this tax ID, including this one
Part of
Ecu School Medicine Cli

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

100 Brunswick Medical Center Pkwy NE
Bolivia, NC 28422
Phone (252) 916-9453

NPI Registry JSON

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

{
    "created_epoch": "1413936000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721952000000",
    "number": "1427452283",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 BRUNSWICK MEDICAL CENTER PARKWAY",
            "city": "BOLIVIA",
            "state": "NC",
            "postal_code": "28422",
            "telephone_number": "910-253-9000",
            "fax_number": "910-253-9033"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 BRUNSWICK MEDICAL CENTER PKWY NE",
            "city": "BOLIVIA",
            "state": "NC",
            "postal_code": "284221001",
            "telephone_number": "910-253-9000",
            "fax_number": "910-253-9033"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST CAROLINA UNIVERSITY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EAST CAROLINA UNIVERSITY",
        "enumeration_date": "2014-10-22",
        "last_updated": "2024-07-26",
        "certification_date": "2024-07-26",
        "status": "A",
        "authorized_official_last_name": "CHADWICK",
        "authorized_official_first_name": "DEXTER",
        "authorized_official_middle_name": "GREGORY",
        "authorized_official_title_or_position": "DEAN, SCHOOL OF DENTAL MEDICINE",
        "authorized_official_telephone_number": "252-737-7000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS, MS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "East Carolina University School of Dental Medicine, CSLC Brunswick",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "ECU School of Dental Medicine",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Bolivia, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.