Provider Demographics
NPI:1922293521
Name:DUSTIN DURDEN DDS, KATINA PITTMAN DDS,PA, /MCCRIMMON FAMILY DENTISTRY
Entity Type:Organization
Organization Name:DUSTIN DURDEN DDS, KATINA PITTMAN DDS,PA, /MCCRIMMON FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROBYN
Authorized Official - Middle Name:SUZANNE
Authorized Official - Last Name:MANCHESTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-380-3060
Mailing Address - Street 1:6402 MCCRIMMON PARKWAY
Mailing Address - Street 2:SUITE #400
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-8136
Mailing Address - Country:US
Mailing Address - Phone:919-380-3060
Mailing Address - Fax:919-380-4494
Practice Address - Street 1:6402 MCCRIMMON PARKWAY
Practice Address - Street 2:SUITE #400
Practice Address - City:MORRISVILLE
Practice Address - State:NC
Practice Address - Zip Code:27560-8136
Practice Address - Country:US
Practice Address - Phone:919-380-3060
Practice Address - Fax:919-380-4494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-07
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC76021223G0001X
NC76491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1871511816Medicare UPIN
NC1225044092Medicare UPIN