1003402322 NPI number — ANGELS OF GRACE, LLC

Table of content: DR. ANH THU DO DDS (NPI 1881730778)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003402322 NPI number — ANGELS OF GRACE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANGELS OF GRACE, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003402322
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/21/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
104 JONES FERRY RD STE A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARRBORO
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27510-2036
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-968-3724
Provider Business Mailing Address Fax Number:
919-551-8320

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
104 JONES FERRY RD STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARRBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27510-2036
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-968-3724
Provider Business Practice Location Address Fax Number:
919-551-8320
Provider Enumeration Date:
12/21/2020

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
IBOAYA
Authorized Official First Name:
EHIMEMEN
Authorized Official Middle Name:
OJEABULU
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
336-831-6380

Provider Taxonomy Codes

  • Taxonomy code: 253Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)