Provider Demographics
NPI:1578662284
Name:CLINE, EDSEL NEIL (DMD)
Entity Type:Individual
Prefix:DR
First Name:EDSEL
Middle Name:NEIL
Last Name:CLINE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205B RESERVE GREEN DR
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28557-8947
Mailing Address - Country:US
Mailing Address - Phone:252-726-9403
Mailing Address - Fax:
Practice Address - Street 1:501 ATLANTIC BEACH CSWY
Practice Address - Street 2:
Practice Address - City:ATLANTIC BEACH
Practice Address - State:NC
Practice Address - Zip Code:28512-7341
Practice Address - Country:US
Practice Address - Phone:252-247-6704
Practice Address - Fax:252-247-3670
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC82131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC9027COtherBCBS