NPIMap

Organization Active NPI

Sue a. Minneman-Fowler, DDS, PLLC

  • Dentist
  • Maysville, NC
National Provider Identifier
1689016206
Registry record updated Jul 24, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
5410 Issued in NC
Legal business name
SUE A. MINNEMAN-FOWLER, DDS, PLLC
Practice address
1002 Jenkins Anenue
Maysville, NC 28555
Phone
(910) 743-2521
Fax
(910) 743-2531
NPI assigned
Jul 24, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 24, 2013

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

Authorized official

Name
Dr. Sue Ann Minneman-Fowler, DDSNPI 1932216629
Title
President/Owner
Phone
(910) 743-2521

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X 5410 NC Primary

Addresses

Primary practice location

1002 Jenkins Anenue
Maysville, NC 28555

Mailing address

1002 Jenkins Avenue
Maysville, NC 28555-0418
Phone (910) 743-2521

Other identifiers 1

IdentifierTypeStateIssuer
5900050MedicaidNC

National Provider Directory

National Provider Directory

Locations

1002 Jenkins Ave
Maysville, NC 28555
Phone (910) 743-2521

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1374624000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1374624000000",
    "number": "1689016206",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1002 JENKINS AVENUE",
            "city": "MAYSVILLE",
            "state": "NC",
            "postal_code": "285550418",
            "telephone_number": "910-743-2521",
            "fax_number": "910-743-2531"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1002 JENKINS ANENUE",
            "city": "MAYSVILLE",
            "state": "NC",
            "postal_code": "28555",
            "telephone_number": "910-743-2521",
            "fax_number": "910-743-2531"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUE A. MINNEMAN-FOWLER, DDS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-07-24",
        "last_updated": "2013-07-24",
        "status": "A",
        "authorized_official_last_name": "MINNEMAN-FOWLER",
        "authorized_official_first_name": "SUE",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "910-743-2521",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "NC",
            "license": "5410",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5900050",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Maysville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2013; 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.