Provider Demographics
NPI:1467965483
Name:LINCOLN DENTAL SERVICES INC.
Entity Type:Organization
Organization Name:LINCOLN DENTAL SERVICES INC.
Other - Org Name:LINCOLN COUNTY DENTAL HEALTH SERVICES INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DOCTOR & BOARD MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:CORDELL
Authorized Official - Middle Name:
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:704-718-1739
Mailing Address - Street 1:111 DOCTORS PARK
Mailing Address - Street 2:
Mailing Address - City:LINCOLNTON
Mailing Address - State:NC
Mailing Address - Zip Code:28092-4407
Mailing Address - Country:US
Mailing Address - Phone:704-735-2230
Mailing Address - Fax:704-735-4577
Practice Address - Street 1:111 DOCTORS PARK
Practice Address - Street 2:
Practice Address - City:LINCOLNTON
Practice Address - State:NC
Practice Address - Zip Code:28092-4407
Practice Address - Country:US
Practice Address - Phone:704-735-2230
Practice Address - Fax:704-735-4577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-13
Last Update Date:2017-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC899012NMedicaid