Active NPI
Ellen Diane Nordgren, DDS
- Dentist
- Goldsboro, NC
National Provider Identifier
1942437033
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 9263
- Practice address
- 2720 Graves Dr
Goldsboro, NC 27534-4512 - Phone
- (919) 778-0098
- NPI assigned
- Jun 16, 2009
- Last updated
- Nov 6, 2013
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | D12705 | MN | |
| Dentist | 122300000X | 9263 | NC | Primary |
Addresses
Primary practice location
2720 Graves Dr
Goldsboro, NC 27534-4512
Mailing address
314 Pickens Dr N
Goldsboro, NC 27530-9097
Phone (507) 363-6157
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 |
|---|---|---|---|
| D12705 | MN | MD | Dentist |
| 9263 | NC | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kyle J Roth III DDS PA | 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba carolina Denta Arts of Goldsboro
- General Practice Dentistry
- Goldsboro, NC
- NPI 1386928083
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1245110400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1383696000000",
"number": "1942437033",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "314 PICKENS DR N",
"city": "GOLDSBORO",
"state": "NC",
"postal_code": "275309097",
"telephone_number": "507-363-6157"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2720 GRAVES DR",
"city": "GOLDSBORO",
"state": "NC",
"postal_code": "275344512",
"telephone_number": "919-778-0098"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NORDGREN",
"first_name": "ELLEN",
"middle_name": "DIANE",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-06-16",
"last_updated": "2013-11-06",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MN",
"license": "D12705",
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NC",
"license": "9263",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Goldsboro, NC
- Nick Columbus Company Inc (NC Mobility)
- Larry C Nickens, MD
- Nicole Bauer Counseling PLLC
- Nicole Williams D.D.S., P.a. (Goldsboro Dental Arts)
- Amy Marie Nolte, COTA
- Brittaney Nores, DPT
- Carina S Norris, OTR/L
- North Carolina CVS Pharmacy LLC (CVS Pharmacy #07021)
- North Carolina CVS Pharmacy LLC (CVS Pharmacy #16373)
- North Carolina Orthotics & Prosthetics of Goldsboro
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 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.