Paul Douglas Nifong Jr., D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

4520 Issued in NC

Practice address

3624 Clemmons Rd.
Clemmons, NC 27012-8873

Phone

(336) 766-6457

NPI assigned

Jul 31, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Paul D. Nifong Jr. Ddspa

  • General Practice Dentistry
  • Clemmons, NC
  • NPI 1437160991
  NPD (past) Authorized official
• David Hong DMD PLLC

  • General Practice Dentistry
  • Clemmons, NC
  • NPI 1457191397
  NPD (past)

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

{
    "created_epoch": "1154304000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1518972934",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 325",
            "city": "CLEMMONS",
            "state": "NC",
            "postal_code": "270120325",
            "telephone_number": "336-766-6457"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3624 CLEMMONS RD.",
            "city": "CLEMMONS",
            "state": "NC",
            "postal_code": "270128873",
            "telephone_number": "336-766-6457"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NIFONG",
        "first_name": "PAUL",
        "middle_name": "DOUGLAS",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-31",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NC",
            "license": "4520",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "899451",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Multi-Therapeutic Services, Inc
• Multi-Therapeutic Services, Inc.
• Meghan Elizabeth Elaine Mutter
• Susan McLeod Myers, MED, LCMHC, NCC, RPT
• Tanuja Nadkarni
• Darin Nolting, PT
• Anna Collins Norman, FNP-C
• North Carolina Baptist Hospital (Medical Plaza-Clemmons Pharmacy)
• North Carolina CVS Pharmacy LLC (CVS Pharmacy # 04253)
• North Carolina CVS Pharmacy LLC (CVS Pharmacy #07026)

• General Practice Dentistry in Clemmons, NC
• Providers in Clemmons, NC by specialty
• General Practice Dentistry in North Carolina

• 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.

Verify at the official NPI Registry.