Provider Demographics
NPI:1194867002
Name:DISDIER & ASSOCIATES, PA
Entity Type:Organization
Organization Name:DISDIER & ASSOCIATES, PA
Other - Org Name:IMMEDIATE DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:DISDIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-939-1400
Mailing Address - Street 1:1001B HARDEE RD
Mailing Address - Street 2:
Mailing Address - City:KINSTON
Mailing Address - State:NC
Mailing Address - Zip Code:28504-3323
Mailing Address - Country:US
Mailing Address - Phone:252-939-1400
Mailing Address - Fax:
Practice Address - Street 1:1001B HARDEE RD
Practice Address - Street 2:
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28504-3323
Practice Address - Country:US
Practice Address - Phone:252-939-1400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC69751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5903565Medicaid