Provider Demographics
NPI:1982632915
Name:UNC ORAL & MAXILLOFACIAL
Entity Type:Organization
Organization Name:UNC ORAL & MAXILLOFACIAL
Other - Org Name:UNC ORAL AND MAXILLOFACIAL PATHOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LABORATORY DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MURRAH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:919-537-3152
Mailing Address - Street 1:150 DENTAL CIR
Mailing Address - Street 2:5603 KOURY OHSB CB 7450
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27599-0001
Mailing Address - Country:US
Mailing Address - Phone:919-537-3153
Mailing Address - Fax:919-843-6508
Practice Address - Street 1:150 DENTAL CIR
Practice Address - Street 2:5603 KOURY OHSB CB 7450
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27599-0001
Practice Address - Country:US
Practice Address - Phone:919-537-3153
Practice Address - Fax:919-843-6508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-29
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial PathologyGroup - Multi-Specialty
No291U00000XLaboratoriesClinical Medical LaboratoryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC34D0710634OtherCLIA-88