Provider Demographics
NPI:1689815284
Name:EAST CAROLINA UNIVERSITY
Entity Type:Organization
Organization Name:EAST CAROLINA UNIVERSITY
Other - Org Name:ECU HOSPITAL DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INTERIM VICE DEAN, ASSOCIATE DEAN,
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANCIS
Authorized Official - Middle Name:GERARD
Authorized Official - Last Name:SERIO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MS, MBA
Authorized Official - Phone:252-737-7004
Mailing Address - Street 1:PO BOX 6072
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-4300
Mailing Address - Country:US
Mailing Address - Phone:252-744-4618
Mailing Address - Fax:252-744-2827
Practice Address - Street 1:600 MOYE BLVD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-4300
Practice Address - Country:US
Practice Address - Phone:252-744-4618
Practice Address - Fax:252-744-2827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-12
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1223G0001X
NC1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8903019Medicaid