Provider Demographics
NPI:1003867524
Name:FIDLER, JOHN E JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:E
Last Name:FIDLER
Suffix:JR
Gender:M
Credentials:DDS
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Mailing Address - Street 1:2400 WAYNE MEMORIAL DR
Mailing Address - Street 2:SUITE K
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-1789
Mailing Address - Country:US
Mailing Address - Phone:919-736-2082
Mailing Address - Fax:919-734-0893
Practice Address - Street 1:2400 WAYNE MEMORIAL DR
Practice Address - Street 2:SUITE K
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-1789
Practice Address - Country:US
Practice Address - Phone:919-736-2082
Practice Address - Fax:919-734-0893
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC75751223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89902J5Medicaid
NC0160988OtherUNITED CONCORDIA
NC902J5OtherBCBS OF NC
NCU97342Medicare UPIN
NC902J5OtherBCBS OF NC