Provider Demographics
NPI:1811091457
Name:DRS SALLING AND TATE
Entity type:Organization
Organization Name:DRS SALLING AND TATE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:L
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-256-9040
Mailing Address - Street 1:2002 EASTWOOD RD
Mailing Address - Street 2:STE 105
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403
Mailing Address - Country:US
Mailing Address - Phone:910-256-9040
Mailing Address - Fax:910-256-2463
Practice Address - Street 1:2002 EASTWOOD RD
Practice Address - Street 2:STE 105
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403
Practice Address - Country:US
Practice Address - Phone:910-256-9040
Practice Address - Fax:910-256-2463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC97551OtherBCBS
27865OtherUNITED CONCORDIA
646240OtherUNITED CONCORDIA
NC9016HOtherBCBS
646240OtherUNITED CONCORDIA