Provider Demographics
NPI:1629472568
Name:EAST CAROLINA UNIVERSITY SCHOOL OF DENTAL MEDICINE-DAVIDSON
Entity Type:Organization
Organization Name:EAST CAROLINA UNIVERSITY SCHOOL OF DENTAL MEDICINE-DAVIDSON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASST CLINICAL ACCOUNTANT
Authorized Official - Prefix:MR
Authorized Official - First Name:ALVA
Authorized Official - Middle Name:JULIUS
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-737-7035
Mailing Address - Street 1:1235 DCCC ROAD
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27360
Mailing Address - Country:US
Mailing Address - Phone:252-737-7035
Mailing Address - Fax:
Practice Address - Street 1:1235 DCCC ROAD
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:NC
Practice Address - Zip Code:27360
Practice Address - Country:US
Practice Address - Phone:252-737-7035
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EAST CAROLINA UNIVERSITY SCHOOL OF DENTAL MEDICINE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-10-21
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty