1073532248 NPI number — DIMOCK WEINBERG & CHERRY DDS PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073532248 NPI number — DIMOCK WEINBERG & CHERRY DDS PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DIMOCK WEINBERG & CHERRY 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:
DIMOCK AND WEINBERG D.D.S., PA
Provider Other Organization Name Type Code:
3
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:
1073532248
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/22/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3505 CONVERSE DR
Provider Second Line Business Mailing Address:
SUITE 175
Provider Business Mailing Address City Name:
WILMINGTON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28403-6131
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-794-2266
Provider Business Mailing Address Fax Number:
910-794-6899

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3505 CONVERSE DR
Provider Second Line Business Practice Location Address:
SUITE 175
Provider Business Practice Location Address City Name:
WILMINGTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28403-6131
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-794-2266
Provider Business Practice Location Address Fax Number:
910-794-6899
Provider Enumeration Date:
07/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TERWILLIGER
Authorized Official First Name:
DONNA
Authorized Official Middle Name:
Authorized Official Title or Position:
FINANCIAL COORDINATOR
Authorized Official Telephone Number:
910-794-2266

Provider Taxonomy Codes

  • Taxonomy code: 1223P0221X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 015AC . This is a "BLUE CROSS GROUP NUMBER" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 89015AC , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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