1528278140 NPI number — JEFFREY W. LINEBERRY, DDS, PLLC

Table of content: (NPI 1528278140)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528278140 NPI number — JEFFREY W. LINEBERRY, DDS, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JEFFREY W. LINEBERRY, 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:
1528278140
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/11/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2226 N HIGHWAY 16
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DENVER
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28037-8254
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-489-9100
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2226 N HIGHWAY 16
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DENVER
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28037-8254
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-489-9100
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LINEBERRY
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
W
Authorized Official Title or Position:
DENTIST
Authorized Official Telephone Number:
704-489-9100

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  7148 , 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: 89 9015N , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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