Provider Demographics
NPI:1912121393
Name:ADAM T. DORSETT, DDS, AND JASON T. MOORE, DDS, PA
Entity Type:Organization
Organization Name:ADAM T. DORSETT, DDS, AND JASON T. MOORE, DDS, PA
Other - Org Name:HILLSDALE DENTAL
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:T
Authorized Official - Last Name:DORSETT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:336-998-2427
Mailing Address - Street 1:127 ROYAL TROON LANE
Mailing Address - Street 2:
Mailing Address - City:ADVANCE
Mailing Address - State:NC
Mailing Address - Zip Code:27006-6651
Mailing Address - Country:US
Mailing Address - Phone:336-998-2427
Mailing Address - Fax:336-998-1088
Practice Address - Street 1:127 ROYAL TROON LANE
Practice Address - Street 2:
Practice Address - City:ADVANCE
Practice Address - State:NC
Practice Address - Zip Code:27006-6651
Practice Address - Country:US
Practice Address - Phone:336-998-2427
Practice Address - Fax:336-998-1088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5901813Medicaid