Gerald L Coates Jr., DMD, PA
Individual provider Active NPI General Practice Dentistry · Havelock, NC
NPI 1528044039 · NPPES record last updated Mar 31, 2016
Key facts
- NPI
- 1528044039
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 5135 (NC)
- Practice address
- 92 Stonebridge TRL
Havelock, NC 28532-9553 - Phone
- (252) 447-3100
- Fax
- (252) 447-0144
- NPI assigned
- Dec 16, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NC
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150625002269 | NC | Order and Referring Only - Oral Surgery |
8820309289 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5135 | NC | MD | School Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| William S. Harvey, III, DDS, PLLC 7 | Past |
Accepting new patients | |
| Gerald L. Coates, Jr., DMD, PA | General Practice | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 5135 | NC | Yes |
Addresses
Primary practice location
92 Stonebridge TRL
Havelock, NC 28532-9553
Mailing address
92 Stonebridge TRL
Havelock, NC 28532-9553
Phone (252) 447-3100
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All providers in Havelock, NC · General Practice Dentistry in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 31, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.