Provider Demographics
NPI:1922309384
Name:MICHAEL T MCALLISTER DDS PA
Entity Type:Organization
Organization Name:MICHAEL T MCALLISTER DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:H
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-259-3733
Mailing Address - Street 1:745 US HIGHWAY 117 S
Mailing Address - Street 2:C
Mailing Address - City:BURGAW
Mailing Address - State:NC
Mailing Address - Zip Code:28425-7746
Mailing Address - Country:US
Mailing Address - Phone:910-259-3733
Mailing Address - Fax:910-259-3734
Practice Address - Street 1:745 US HIGHWAY 117 S
Practice Address - Street 2:C
Practice Address - City:BURGAW
Practice Address - State:NC
Practice Address - Zip Code:28425-7746
Practice Address - Country:US
Practice Address - Phone:910-259-3733
Practice Address - Fax:910-259-3734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-16
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC77851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89902U4Medicaid