Provider Demographics
NPI:1972650059
Name:STOPPELBEIN & HARDISON, DDS PA
Entity Type:Organization
Organization Name:STOPPELBEIN & HARDISON, DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:STOPPELBEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MPH
Authorized Official - Phone:910-293-4940
Mailing Address - Street 1:PO BOX 424
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:NC
Mailing Address - Zip Code:28398-0424
Mailing Address - Country:US
Mailing Address - Phone:910-293-4940
Mailing Address - Fax:
Practice Address - Street 1:121 DUPLIN PROFESSIONAL COURT
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:NC
Practice Address - Zip Code:28398-0424
Practice Address - Country:US
Practice Address - Phone:910-293-4940
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC52421223G0001X
NC72821223G0001X
NC104781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0206HOtherBLUE CROSS BLUE SHIELD
NC890206HMedicaid