Provider Demographics
NPI:1790866564
Name:UNIVERSITY OF NORTH CAROLINA AT CHAPEL HILL
Entity Type:Organization
Organization Name:UNIVERSITY OF NORTH CAROLINA AT CHAPEL HILL
Other - Org Name:ORAL MAXILLOFACIAL SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:H
Authorized Official - Last Name:BLAKEY
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS
Authorized Official - Phone:919-537-3944
Mailing Address - Street 1:140 DENTAL CIRCLE
Mailing Address - Street 2:SUITE 115
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27599-7450
Mailing Address - Country:US
Mailing Address - Phone:919-537-3944
Mailing Address - Fax:919-966-6019
Practice Address - Street 1:115 BRAUER HALL
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27599-7450
Practice Address - Country:US
Practice Address - Phone:919-537-3944
Practice Address - Fax:919-966-6019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0212FOtherBCBS OF NC GROUP #
NC0212FOtherBCBS OF NC GROUP #