Active NPI
Alan Kuo, DDS
- General Practice Dentistry
- Fayetteville, NC
National Provider Identifier
1710415229
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 10974
- Practice address
- 1400 Walter Reed Rd Ste 200
Fayetteville, NC 28304 - Phone
- (910) 864-9884
- NPI assigned
- May 28, 2017
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 10974 | NC | Primary |
Addresses
Primary practice location
1400 Walter Reed Rd Ste 200
Fayetteville, NC 28304
Mailing address
510 N Wilmington St Apt 401
Raleigh, NC 27604-8034
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10974 | NC | MD | Orthopedic Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ballance & Derose DDS PA | General Practice | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- General Practice Dentistry
- Fayetteville, NC
- NPI 1386677961
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1495929600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1532390400000",
"number": "1710415229",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "510 N WILMINGTON ST APT 401",
"city": "RALEIGH",
"state": "NC",
"postal_code": "276048034"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1400 WALTER REED RD STE 200",
"city": "FAYETTEVILLE",
"state": "NC",
"postal_code": "28304",
"telephone_number": "910-864-9884"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KUO",
"first_name": "ALAN",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-05-28",
"last_updated": "2018-07-24",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "NC",
"license": "10974",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fayetteville, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.