Provider Demographics
NPI:1760695589
Name:DRS.T.LENISE & CHARLES U. MAUNEY,JR.,PLLC
Entity Type:Organization
Organization Name:DRS.T.LENISE & CHARLES U. MAUNEY,JR.,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:U
Authorized Official - Last Name:MAUNEY, JR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-933-1007
Mailing Address - Street 1:223 TIMBERHILL PL
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-1597
Mailing Address - Country:US
Mailing Address - Phone:919-933-1007
Mailing Address - Fax:919-933-7118
Practice Address - Street 1:223 TIMBERHILL PL
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-1597
Practice Address - Country:US
Practice Address - Phone:919-933-1007
Practice Address - Fax:919-933-7118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC62421223P0221X
NC61281223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Not Answered1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89018RMedicaid