Provider Demographics
NPI:1023036837
Name:ARTHUR & NICHOLSON, DDS, PA
Entity type:Organization
Organization Name:ARTHUR & NICHOLSON, DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:B
Authorized Official - Last Name:OVERTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-537-1054
Mailing Address - Street 1:551 BECKER DRIVE
Mailing Address - Street 2:
Mailing Address - City:ROANOKE RAPIDS
Mailing Address - State:NC
Mailing Address - Zip Code:27870-3303
Mailing Address - Country:US
Mailing Address - Phone:252-537-1054
Mailing Address - Fax:252-537-1211
Practice Address - Street 1:551 BECKER DR
Practice Address - Street 2:
Practice Address - City:ROANOKE RAPIDS
Practice Address - State:NC
Practice Address - Zip Code:27870-3303
Practice Address - Country:US
Practice Address - Phone:252-537-1054
Practice Address - Fax:252-537-1211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2018-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC49081223G0001X
1223G0001X
NC62011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC017CHOtherNCBCBS GROUP PROV. NO.
VA240107OtherVABCBS GROUP PROV. NO.
NC8993995Medicaid