East Carolina University
Organization Active NPI Dentist · Lillington, NC
NPI 1942633482 · NPPES record last updated Jul 26, 2024
Key facts
- NPI
- 1942633482
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Dentist 122300000X
- Legal business name
- EAST CAROLINA UNIVERSITY
- Practice address
- 80 Autumn Fern Trail
Lillington, NC 27546 - Phone
- (910) 814-4191
- Fax
- (910) 814-4198
- NPI assigned
- Aug 20, 2013
- Organization subpart
- No
Authorized official
- Name
- Dr. Dexter Gregory Chadwick, DDS, MS
- Title
- Dean, School of Dental Medicine
- Phone
- (252) 737-7000
Other NPIs on the same Medicare enrollment 13
Corporate family (same tax ID) 14
Member organizations 4
Practitioners 7
-
Randall Neal Ball, DDS
-
Michael A Hoffman, DDS
-
Roopwant Kaur, BDS,MS
-
Moamen E Sheba, BDS, MS
-
Ryan Scott Wordsworth, PA-C
-
Susan Barr Jones, DMD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NC
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031106000400 | NC | Part B Supplier - Clinic/Group Practice | 0244143246 |
Receives reassigned benefits from 978 practitioners 13 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Greenville, NC; Lillington, NC; Lumberton, NC; Robersonville, NC; Spruce Pine, NC; Sylva, NC; Thomasville, NC; Washington, NC… |
National Provider Directory
- Tax ID family
- East Carolina University Student Health Service
Locations
80 Autumn Fern Trl
Lillington, NC 27546
Phone (252) 737-7350
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist |
122300000X | Yes |
Addresses
Primary practice location
80 Autumn Fern Trail
Lillington, NC 27546
Mailing address
80 Autumn Fern Trail
Lillington, NC 27546
Phone (910) 814-4191
Other names
- ECU School of Dental Medicine CSLC Lillington
Other providers in Lillington, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 26, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.