Carolina Pediatric Dental Management, LLC

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

Legal business name

CAROLINA PEDIATRIC DENTAL MANAGEMENT, LLC

Practice address

3000 New Bern Ave
Raleigh, NC 27610-1231

Phone

(919) 570-0180

NPI assigned

Dec 20, 2023

Last updated

Dec 20, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Amena Holley

Title

Credentialing Specialist

Phone

(248) 550-5440

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1703030400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1703030400000",
    "number": "1669240586",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13580 GROUPE DR STE 305",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221924165"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3000 NEW BERN AVE",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276101231",
            "telephone_number": "919-570-0180"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2620 New Bern Ave",
            "address_purpose": "LOCATION",
            "city": "Raleigh",
            "state": "NC",
            "postal_code": "276101821",
            "country_code": "US",
            "telephone_number": "919-570-0180",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CAROLINA PEDIATRIC DENTAL MANAGEMENT, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-12-20",
        "last_updated": "2023-12-20",
        "certification_date": "2023-12-20",
        "status": "A",
        "authorized_official_last_name": "HOLLEY",
        "authorized_official_first_name": "AMENA",
        "authorized_official_title_or_position": "CREDENTIALING  SPECIALIST",
        "authorized_official_telephone_number": "248-550-5440"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carolina Outreach, LLC
• Carolina Outreach, LLC
• Carolina Partners in Mental (Carolina Partners of Raleigh NC)
• Carolina Pathways Counseling & Consulting
• Carolina Pathways LLC
• Carolina Pediatric Dysphagia
• Carolina Pediatric Therapy Services, Inc.
• Carolina Pelvic Health Center, Inc.
• Carolina Performance Services, PA (Carolina Performance)
• Carolina Physical Therapy Associates LLC (CORA Physical Therapy - Clayton)

• Pediatric Dentistry in Raleigh, NC
• Providers in Raleigh, NC by specialty
• Pediatric Dentistry in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2023; 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.