NPIMap

Organization Active NPI

Anderson and Slack PA

  • General Practice Dentistry
  • Jacksonville, NC
National Provider Identifier
1508976440
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
2996 Issued in NC
Legal business name
ANDERSON AND SLACK PA
Practice address
200 Doctors Drive
Suite F
Jacksonville, NC 28546
Phone
(910) 353-4242
Fax
(910) 577-6421
NPI assigned
Aug 30, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Wayne Clark Anderson, DDS
Title
DDS
Phone
(910) 353-4242

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 2996 NC Primary

Addresses

Primary practice location

200 Doctors Drive
Suite F
Jacksonville, NC 28546

Mailing address

200 Doctors Drive
Suite F
Jacksonville, NC 28546
Phone (910) 353-4242

Other identifiers 3

IdentifierTypeStateIssuer
2996OtherNCDELTA
02211OtherNCBCBS
8990244MedicaidNC

National Provider Directory

National Provider Directory

Locations

200 Doctors Dr
Ste F
Jacksonville, NC 28546
Phone (910) 353-1499

Practitioners & affiliated clinicians

Practitioners 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1508976440",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 DOCTORS DRIVE",
            "address_2": "SUITE F",
            "city": "JACKSONVILLE",
            "state": "NC",
            "postal_code": "28546",
            "telephone_number": "910-353-4242",
            "fax_number": "910-577-6421"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 DOCTORS DRIVE",
            "address_2": "SUITE F",
            "city": "JACKSONVILLE",
            "state": "NC",
            "postal_code": "28546",
            "telephone_number": "910-353-4242",
            "fax_number": "910-577-6421"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANDERSON AND SLACK PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-30",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "WAYNE",
        "authorized_official_middle_name": "CLARK",
        "authorized_official_title_or_position": "DDS",
        "authorized_official_telephone_number": "910-353-4242",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NC",
            "license": "2996",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DELTA",
            "identifier": "2996",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "02211",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8990244",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, 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.

Verify at the official NPI Registry.