Provider Demographics
NPI:1316000110
Name:SCHRIMPER, KEVIN CHARLES (DDS)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:CHARLES
Last Name:SCHRIMPER
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 1:1512 S WINSTEAD AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27803-1650
Mailing Address - Country:US
Mailing Address - Phone:252-937-7878
Mailing Address - Fax:252-937-6086
Practice Address - Street 1:1512 S WINSTEAD AVE
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27803-1650
Practice Address - Country:US
Practice Address - Phone:252-937-7878
Practice Address - Fax:252-937-6086
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC64111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6411OtherLICENSE