Provider Demographics
NPI:1639318744
Name:UNC ORAL & MAXILLOFACIAL RADIOLOGY
Entity Type:Organization
Organization Name:UNC ORAL & MAXILLOFACIAL RADIOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIR OMFS RADIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:A
Authorized Official - Last Name:TYNDALL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:919-966-2746
Mailing Address - Street 1:UNIV OF NORTH CAROLINA AT CHAPEL HL
Mailing Address - Street 2:101 BRAUER HALL CB 7450
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27599-0001
Mailing Address - Country:US
Mailing Address - Phone:919-966-2746
Mailing Address - Fax:919-966-6019
Practice Address - Street 1:UNIV OF NORTH CAROLINA AT CHAPEL HL
Practice Address - Street 2:101 BRAUER HALL CB 7450
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27599-0001
Practice Address - Country:US
Practice Address - Phone:919-966-2746
Practice Address - Fax:919-966-6019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-12
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC48201223X0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0008XDental ProvidersDentistOral and Maxillofacial RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCU17733Medicare UPIN