1396958328 NPI number — DR. HOWARD BRADY SAUNDERS DDS

Table of content: DR. HOWARD BRADY SAUNDERS DDS (NPI 1396958328)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396958328 NPI number — DR. HOWARD BRADY SAUNDERS DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SAUNDERS
Provider First Name:
HOWARD
Provider Middle Name:
BRADY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SAUNDERS
Provider Other First Name:
HOWARD
Provider Other Middle Name:
BRADY
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DDS
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1396958328
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 526
Provider Second Line Business Mailing Address:
205 WEST BURNETTE ST.
Provider Business Mailing Address City Name:
PINETOPS
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27864-0526
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-827-4028
Provider Business Mailing Address Fax Number:
252-827-4028

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
205 WEST BURNETTE ST.
Provider Second Line Business Practice Location Address:
205 WEST BURNETTE ST.
Provider Business Practice Location Address City Name:
PINETOPS
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27864-0526
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-827-4028
Provider Business Practice Location Address Fax Number:
252-827-4028
Provider Enumeration Date:
05/07/2007

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:  4449 , 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: 8997586 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 97586 . This is a "BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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