Provider Demographics
NPI:1912977802
Name:MEADOWS LUTCAVAGE SMITH VINTON FIDLER LONG & ARMSTRONG PA
Entity Type:Organization
Organization Name:MEADOWS LUTCAVAGE SMITH VINTON FIDLER LONG & ARMSTRONG PA
Other - Org Name:EASTERN CAROLINA ORAL AND MAXILLOFACIAL SURGERY ASSOCIATES
Other - Org Type:Other Name
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:RALPH
Authorized Official - Last Name:VINTON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:252-247-2258
Mailing Address - Street 1:501 PENNY LANE
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28557
Mailing Address - Country:US
Mailing Address - Phone:252-247-2258
Mailing Address - Fax:252-247-7783
Practice Address - Street 1:501 PENNY LANE
Practice Address - Street 2:
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557
Practice Address - Country:US
Practice Address - Phone:252-247-2258
Practice Address - Fax:252-247-7783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-24
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC48721223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1749169OtherUNITED CONCORDIA, DR. LON
NE899000LMedicaid
NC8997871Medicaid
NC9018POtherBCBSNC, LONG
NC97871OtherBCBSNC, SMITH
822407OtherUNITED CONCORDIA, SMITH
NC899018PMedicaid
79096OtherUNITED CONCORDIA, VINTON
NC9000LOtherBCBSNC, VINTON
NC97871OtherBCBSNC, SMITH
1749169OtherUNITED CONCORDIA, DR. LON
79096OtherUNITED CONCORDIA, VINTON
2428604Medicare ID - Type UnspecifiedPROVIDER JEFFREY R. VINTO
NC899018PMedicaid
NC8997871Medicaid