1033556162 NPI number — TROY B SLUDER III DDS PLLC

Table of content: (NPI 1033556162)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033556162 NPI number — TROY B SLUDER III DDS PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TROY B SLUDER III DDS PLLC
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:
1033556162
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/30/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 490
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MANTEO
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27954-0490
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-475-9841
Provider Business Mailing Address Fax Number:
252-475-9843

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
503 CYPRESS LANE SUITE C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANTEO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27954
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-475-9841
Provider Business Practice Location Address Fax Number:
252-475-9843
Provider Enumeration Date:
05/30/2013

Additional Information

Authorized Official

Authorized Official Last Name:
SLUDER
Authorized Official First Name:
TROY
Authorized Official Middle Name:
B
Authorized Official Title or Position:
DENTIST
Authorized Official Telephone Number:
252-475-9841

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  5847 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 7997855 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com