Provider Demographics
NPI:1255033478
Name:ERIC SEDERS DDS PLLC II
Entity type:Organization
Organization Name:ERIC SEDERS DDS PLLC II
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:SEDERS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:336-314-9964
Mailing Address - Street 1:209 E BOGUE BLVD
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC BEACH
Mailing Address - State:NC
Mailing Address - Zip Code:28512-0138
Mailing Address - Country:US
Mailing Address - Phone:336-314-9964
Mailing Address - Fax:
Practice Address - Street 1:8048 MARKET ST STE A
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28411-9384
Practice Address - Country:US
Practice Address - Phone:910-686-6578
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-21
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC010644628Medicaid
NC246654581Medicaid
NC85-1900076Medicaid
NC1629181235Medicaid