Provider Demographics
NPI:1255783197
Name:UNC SCHOOL OF DENTISTRY
Entity type:Organization
Organization Name:UNC SCHOOL OF DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AEGD PROGRAM
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ARMBRUSTER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:270-559-9001
Mailing Address - Street 1:385 S COLUMBIA ST
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27599-7450
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:385 S COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27599-7450
Practice Address - Country:US
Practice Address - Phone:919-537-3737
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-04
Last Update Date:2016-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCDE7647OtherMEDICAID UPIN