NPIMap

Organization Active NPI

Meadows Lutcavage Smith Vinton Fidler & Long DDS PA

  • Oral and Maxillofacial Surgery (Dentist)
  • Goldsboro, NC
National Provider Identifier
1992754311
Registry record updated Sep 18, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
Legal business name
MEADOWS LUTCAVAGE SMITH VINTON FIDLER & LONG DDS PA
Practice address
2400 Wayne Memorial Dr
Suite K
Goldsboro, NC 27534-1789
Phone
(919) 736-2082
Fax
(919) 734-0893
NPI assigned
May 10, 2006
Last updated
Sep 18, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 18, 2009

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

Authorized official

Name
Dr. Gregory J Lutcavage, D.D.S.NPI 1518917657
Title
Partner
Phone
(919) 736-2082

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
Oral and Maxillofacial Surgery (Dentist) 1223S0112X NC Primary

Addresses

Primary practice location

2400 Wayne Memorial Dr
Suite K
Goldsboro, NC 27534-1789

Mailing address

2400 Wayne Memorial Dr
Suite K
Goldsboro, NC 27534-1789
Phone (919) 736-2082

Other identifiers 2

IdentifierTypeStateIssuer
89016C1MedicaidNC
016C1OtherNCBLUE CROSS BLUE SHIELD

National Provider Directory

National Provider Directory

Locations

2400 Wayne Memorial Dr
Ste K
Goldsboro, NC 27534
Phone (919) 736-2082

Practitioners & affiliated clinicians

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1147219200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1253232000000",
    "number": "1992754311",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2400 WAYNE MEMORIAL DR",
            "address_2": "SUITE K",
            "city": "GOLDSBORO",
            "state": "NC",
            "postal_code": "275341789",
            "telephone_number": "919-736-2082",
            "fax_number": "919-734-0893"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2400 WAYNE MEMORIAL DR",
            "address_2": "SUITE K",
            "city": "GOLDSBORO",
            "state": "NC",
            "postal_code": "275341789",
            "telephone_number": "919-736-2082",
            "fax_number": "919-734-0893"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEADOWS LUTCAVAGE SMITH VINTON FIDLER & LONG DDS PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-10",
        "last_updated": "2009-09-18",
        "status": "A",
        "authorized_official_last_name": "LUTCAVAGE",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "919-736-2082",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89016C1",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "016C1",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Goldsboro, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2009; 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.