1063597474 NPI number — DR. WILLIAM JOUETTE TAPP III D.D.S.

Table of content: DR. WILLIAM JOUETTE TAPP III D.D.S. (NPI 1063597474)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063597474 NPI number — DR. WILLIAM JOUETTE TAPP III D.D.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TAPP
Provider First Name:
WILLIAM
Provider Middle Name:
JOUETTE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
III
Provider Credential Text:
D.D.S.
Provider Gender Code:
M

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:
1063597474
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1018 HWY 70 WEST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GARNER
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27529-2562
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-779-2609
Provider Business Mailing Address Fax Number:
919-779-4451

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1018 HWY 70 WEST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GARNER
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27529-2562
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-779-2609
Provider Business Practice Location Address Fax Number:
919-779-4451
Provider Enumeration Date:
10/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  4259 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1223G0001X , with the licence number: 2324 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 98256 . This is a "BLUE CROSS & BLUE SHILD" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 2324 . This is a "DENTAL LIC. NUMBER" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 4259 . This is a "DENTAL LIC. NUMBER" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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