Samuel G Koonce Jr., D.D.S.

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

4365 Issued in NC

Practice address

900 Spivey Rd
Whiteville, NC 28472

Phone

(910) 642-4529

Fax

(910) 642-4354

NPI assigned

Feb 15, 2007

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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.

• Samuel G. Koonce, Jr., DDS, PA

  • Dental Clinic/Center
  • Whiteville, NC
  • NPI 1689842163
  NPD (past) Authorized official

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

{
    "created_epoch": "1171497600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1720121718",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 965",
            "address_2": "900 SPIVEY RD",
            "city": "WHITEVILLE",
            "state": "NC",
            "postal_code": "284720965",
            "telephone_number": "910-642-4529",
            "fax_number": "910-642-4354"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 SPIVEY RD",
            "city": "WHITEVILLE",
            "state": "NC",
            "postal_code": "28472",
            "telephone_number": "910-642-4529",
            "fax_number": "910-642-4354"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOONCE",
        "first_name": "SAMUEL",
        "middle_name": "G",
        "name_suffix": "Jr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-15",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "NC",
            "license": "4365",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8995053",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Peter Michael Kindschuh, MD
• Cythia Moseley Kirby
• Thomas R. Kirby, OD
• Arfana Ahmed Kishan
• Anna Turbeville Klara, OTR/L
• Alexander Kotlarevsky, MD
• Andrew Peter Kovacs, MD
• Christian Horton Lane, RTR,RCS
• Clifton Lavenhouse
• Brent C Lawson, DDS

• Orthodontics and Dentofacial Orthopedics Dentistry in Whiteville, NC
• Providers in Whiteville, NC by specialty
• Orthodontics and Dentofacial Orthopedics 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.