Provider Demographics
NPI:1801117759
Name:E. HUNTER PIERCE DMD PA
Entity type:Organization
Organization Name:E. HUNTER PIERCE DMD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:EVAN
Authorized Official - Middle Name:HUNTER
Authorized Official - Last Name:PIERCE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:910-762-0991
Mailing Address - Street 1:1902 GLEN MEADE ROAD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-6096
Mailing Address - Country:US
Mailing Address - Phone:910-762-0991
Mailing Address - Fax:910-762-4605
Practice Address - Street 1:1902 GLEN MEADE ROAD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-6096
Practice Address - Country:US
Practice Address - Phone:910-762-0991
Practice Address - Fax:910-762-4605
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:E. HUNTER PIERCE DMD PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-06-15
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC82531223G0001X
NC33011223G0001X
1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC9036KMedicaid
NC96873Medicaid