Provider Demographics
NPI:1205046703
Name:R. SCOTT EIDSON,DDS, P.A.
Entity type:Organization
Organization Name:R. SCOTT EIDSON,DDS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:APPLEBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-758-4415
Mailing Address - Street 1:504 MULBERRY ST SW
Mailing Address - Street 2:
Mailing Address - City:LENOIR
Mailing Address - State:NC
Mailing Address - Zip Code:28645-5725
Mailing Address - Country:US
Mailing Address - Phone:828-758-4415
Mailing Address - Fax:828-758-4494
Practice Address - Street 1:504 MULBERRY ST SW
Practice Address - Street 2:
Practice Address - City:LENOIR
Practice Address - State:NC
Practice Address - Zip Code:28645-5725
Practice Address - Country:US
Practice Address - Phone:828-758-4415
Practice Address - Fax:828-758-4494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4482261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8992462Medicaid
NCT63872Medicare UPIN