Provider Demographics
NPI:1922176791
Name:STUDENT DENTAL CLINICS, UNC SCHOOL OF DENTISTRY
Entity Type:Organization
Organization Name:STUDENT DENTAL CLINICS, UNC SCHOOL OF DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE DEAN FOR CLINICAL AFFAIRS
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:SOLOW
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MBA
Authorized Official - Phone:919-966-2810
Mailing Address - Street 1:UNC SCHOOL OF DENTISTRY
Mailing Address - Street 2:BRAUER HALL CB 7450
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27599-7450
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:UNC SCHOOL OF DENTISTRY
Practice Address - Street 2:BRAUER HALL CB 7450
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27599-7450
Practice Address - Country:US
Practice Address - Phone:919-966-1221
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8990138Medicaid