Provider Demographics
NPI:1558569350
Name:CHAPEL HILL PERIODONTICS & IMPLANTS
Entity Type:Organization
Organization Name:CHAPEL HILL PERIODONTICS & IMPLANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:W
Authorized Official - Last Name:GODSEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS, PA
Authorized Official - Phone:919-968-1778
Mailing Address - Street 1:7120 CRESCENT RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27516-5288
Mailing Address - Country:US
Mailing Address - Phone:919-942-4729
Mailing Address - Fax:
Practice Address - Street 1:150 PROVIDENCE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-2208
Practice Address - Country:US
Practice Address - Phone:919-968-1778
Practice Address - Fax:919-408-0706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-03
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC59101223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty