Provider Demographics
NPI:1790956829
Name:DR. PRIVETTE & ASSOCIATES, PA
Entity Type:Organization
Organization Name:DR. PRIVETTE & ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTISAT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:JAMMAR
Authorized Official - Last Name:PRIVETTE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:919-465-0799
Mailing Address - Street 1:970 NORTHWOODS DRIVE
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-3904
Mailing Address - Country:US
Mailing Address - Phone:919-465-0799
Mailing Address - Fax:919-465-0797
Practice Address - Street 1:970 NORTHWOODS DR
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-3803
Practice Address - Country:US
Practice Address - Phone:919-465-0799
Practice Address - Fax:919-465-0797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-17
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6901122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8990098Medicaid