Provider Demographics
NPI:1982028759
Name:EAST CAROLINA UNIVERSITY
Entity Type:Organization
Organization Name:EAST CAROLINA UNIVERSITY
Other - Org Name:EAST CAROLINA UNIVERSITY SCHOOL OF DENTAL MEDICINE, SYLVA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR, COMMUNITY DENTAL PRACTICE
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:SCHOLTZ
Authorized Official - Suffix:
Authorized Official - Credentials:MDM
Authorized Official - Phone:252-737-7029
Mailing Address - Street 1:316 COUNTY SERVICES PARK
Mailing Address - Street 2:ECU SCHOOL OF DENTAL MEDICINE,
Mailing Address - City:SYLVA
Mailing Address - State:NC
Mailing Address - Zip Code:28779
Mailing Address - Country:US
Mailing Address - Phone:828-586-1200
Mailing Address - Fax:828-586-1218
Practice Address - Street 1:316 COUNTY SERVICES PARK
Practice Address - Street 2:ECU SCHOOL OF DENTAL MEDICINE,
Practice Address - City:SYLVA
Practice Address - State:NC
Practice Address - Zip Code:28779
Practice Address - Country:US
Practice Address - Phone:828-586-1200
Practice Address - Fax:828-586-1218
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EAST CAROLINA UNIVERSITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-02-13
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty