Provider Demographics
NPI:1093736357
Name:UPCHURCH, TOMMY DORSEY (DDS)
Entity Type:Individual
Prefix:MR
First Name:TOMMY
Middle Name:DORSEY
Last Name:UPCHURCH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2021 EAST CHESTER DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27265
Mailing Address - Country:US
Mailing Address - Phone:336-885-6511
Mailing Address - Fax:336-885-6577
Practice Address - Street 1:2021 EAST CHESTER DR
Practice Address - Street 2:SUITE 101
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27265
Practice Address - Country:US
Practice Address - Phone:336-885-6511
Practice Address - Fax:336-885-6577
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-22
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3102122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8998758Medicaid
NC8998758Medicaid