Provider Demographics
NPI:1982870713
Name:GERALD W. UPTON, DDS, MS, PHD, PA
Entity Type:Organization
Organization Name:GERALD W. UPTON, DDS, MS, PHD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:TUARNER
Authorized Official - Last Name:RAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-847-1050
Mailing Address - Street 1:8300 HEALTH PARK
Mailing Address - Street 2:SUITE 215
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-4730
Mailing Address - Country:US
Mailing Address - Phone:919-847-1050
Mailing Address - Fax:919-847-1060
Practice Address - Street 1:8300 HEALTH PARK
Practice Address - Street 2:SUITE 215
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-4730
Practice Address - Country:US
Practice Address - Phone:919-847-1050
Practice Address - Fax:919-847-1060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC49641223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial PathologyGroup - Single Specialty