Provider Demographics
NPI:1376569624
Name:BAXTER B. SAPP, JR, DDS & HT MACON SAPP, DDS, PA
Entity Type:Organization
Organization Name:BAXTER B. SAPP, JR, DDS & HT MACON SAPP, DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS/VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HAL THOMAS
Authorized Official - Middle Name:MACON
Authorized Official - Last Name:SAPP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-489-9171
Mailing Address - Street 1:3612 SHANNON RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-6329
Mailing Address - Country:US
Mailing Address - Phone:919-489-9171
Mailing Address - Fax:919-493-1088
Practice Address - Street 1:3612 SHANNON RD
Practice Address - Street 2:SUITE 205
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-6329
Practice Address - Country:US
Practice Address - Phone:919-489-9171
Practice Address - Fax:919-493-1088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty