Provider Demographics
NPI:1336306471
Name:HENRY D DUNCAN DDS PA
Entity Type:Organization
Organization Name:HENRY D DUNCAN DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:DAVIS
Authorized Official - Last Name:DUNCAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:704-933-2116
Mailing Address - Street 1:814 SLOOP AVE
Mailing Address - Street 2:
Mailing Address - City:KANNAPOLIS
Mailing Address - State:NC
Mailing Address - Zip Code:28083-2992
Mailing Address - Country:US
Mailing Address - Phone:704-933-2116
Mailing Address - Fax:704-932-2195
Practice Address - Street 1:814 SLOOP AVE
Practice Address - Street 2:
Practice Address - City:KANNAPOLIS
Practice Address - State:NC
Practice Address - Zip Code:28083-2992
Practice Address - Country:US
Practice Address - Phone:704-933-2116
Practice Address - Fax:704-932-2195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-16
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC37841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC438379OtherUNITED CONCORDIA PROVIDER NUMBER
NC8992238Medicaid